Trend analysis of gastric cancer incidence in Iran and its six geographical areas during 2000-2005

The quantification and clinical analysis of depression and anxiety in patients undergoing Da Vinci robot-assisted radical gastrectomy and open radical gastrectomy

The purpose of paper is to investigate the depression and anxiety as well as independent influential factors between patients who underwent Da Vinci robot-assisted radical gastrectomy and radical gastrectomy. This study is a partially randomized patient preference trial. A total of 98 patients with gastric cancer were divided into the Da Vinci robot-assisted radical gastrectomy group (46 patients, observation group) and open radical gastrectomy group (52 patients, control group). They were also postoperatively and preoperatively measured with Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS). The postoperative and preoperative data of each group were compared. The postoperative and preoperative standard scores of SDS and SAS in patients with the observation group were NS differences (P > 0.05). In the conventional control group, the postoperative mean scores of SDS and SAS were significantly higher than those in the preoperative mean scores and the postoperative mean scores of the observation group, respectively (P < 0.01). The multivariate logistic regression analysis indicated that the independent influential factors of depression and anxiety in patients with radical gastrectomy included tumor, node, metastases stage, pain grading, other postoperative complications and postoperative insomnia (P < 0.05). Robot-assisted radical gastrectomy for gastric carcinoma is conductive to relieving patients' anxiety and depression and improving their quality of life due to the advantages of relatively low incidence of pain, reduced complications and relatively good sleep.

Epidemiologic Study of Gastric Cancer in Iran: A Systematic Review

BACKGROUND

Gastric cancer (GC) is one of the most common cancers in Iran. Knowledge of the epidemiology of the disease is essential in planning for prevention. So this study aimed to investigate the epidemiological aspects of gastric cancer including prevalence, incidence, mortality, and risk factors of Iran.

METHODS

This systematic review study was based on articles published in both English and Persian languages during the years of 1970-2020 in international databases (PubMed, Web of Science, Scopus) and national databases (including SID, Magiran, and IranDoc). Papers related to epidemiological aspects of the disease including mortality, prevalence, incidence, and risk entered the final review.

RESULTS

According to the studies, the minimum and maximum prevalence of gastric cancer in northwestern Iran (Ardabil) is between 0.2 and 100 per 100,000. Also, the death rate per 100,000 people ranged from 10.6 to 15.72 and the ASMR ranged from 4.2 to 32.2%. On the other hand, the incidence of GC was higher in men than in women (74.9 vs 4.6%). The GC risk ratio was 8-times higher in the elderly than in the other age groups (HR=8.0, 2.7-23.5). The incidence of gastric cancer in patients with H. pylori infection was 18-times and that of smokers 2-times higher than other populations. Low level of economic situation and food insecurity increased the odds of GC by 2.42- and 2.57-times, respectively. It should be noted that there was a direct relationship between consumption of processed red meat, dairy products, fruit juice, smoked and salty fish and legumes, strong and hot tea, and consumption of salt and gastric cancer incidence. There was also an inverse relationship between citrus consumption, fresh fruit, garlic, and gastric cancer. In addition, the mRNA genes are the most GC-related genes.

CONCLUSION

Given the high incidence of GC in Iran, changing lifestyle and decreasing consumption of preservatives in food, increasing consumption of fruits and vegetables, and improving the lifestyle can be effective in reducing the incidence of this disease.

A 12-year trend analysis of the incidence of gastrointestinal cancers in East Azerbaijan: last updated results of an ongoing population-based cancer registry

BACKGROUND

The most recent results of Global Cancer Statistics indicated that gastrointestinal cancers, including gastric, colorectal, esophageal, and liver cancers, are among the most commonly diagnosed cancers worldwide. Previous reports from cancer registries in East Azerbaijan have shown that there is a high incidence of gastrointestinal cancer in this region, so we performed a trend analysis to determine the pattern of change over the last decade.

METHODS

In total, 12 years of cancer registry data were collected from different sources in East Azerbaijan, and a data quality check was performed to ensure clean data. Using the 2000 World Health Organization standard population, we then generated age-standardized incidence rates (ASRs) for different cancers, and for each year from 1383 to 1394 of the Persian calendar (i.e., 19 March 2004 to 20 March 2015). Annual percent changes (APCs) and Average annual percent changes (AAPCs) in the ASRs for esophageal, gastric, small intestine, colorectal, anal, liver, gallbladder, and pancreatic cancers were calculated using Joinpoint Software (Version 4.5.0.1, June 2017).

RESULTS

An increase in most types of cancer was observed during the study period. The ASR for colorectal cancer increased from 2.9 to 13.6 per 100,000 women (APC, 9.7%) and from 2.2 to 17.8 per 100,000 men (APC, 10.2%). The ASR for gastric cancer showed a slight increasing trend from 10.5 to 13.5 per 100,000 women (APC, 1.3%) and from 3.1 to 29.9 per 100,000 men (APC, 3.2%). However, trend analysis showed a decreasing pattern for the ASR of esophageal cancer in both genders (APC,- 3%), with APCs of - 1.1% in females and - 0.4% in males.

CONCLUSIONS

The latest results of the East Azerbaijan Population-Based Cancer Registry indicate that gastrointestinal cancers remain common, with significant increasing trends in their ASRs. Improved screening and early detection are needed in this region.

Trends and Risk Factors of Gastric Cancer in Iran (2005-2010)

Background:

Gastric cancer (GC) is the first and the third prevalent cancer among males and females in Iran, respectively. The aim of this study was mainly to identify high-risk areas of GC by assessing the spatial and temporal pattern of incidence, and second, to explore some risk factors of GC in ecological setting.

Methods:

In this cross-sectional ecological study we used Bayesian hierarchical space-time model to measure the relative risk and temporal trends of GC in Iran from 2005 to 2010 based on available data. Data analysis was done by the use of integrated nested Laplace approximation Bayesian approach in R software.

Results:

Overall trend of GC was significantly decreasing during the study period. Ardabil, Khorasan Razavi, West Azarbaijan, Zanjan, and Mazandaran provinces had the highest risk of incidence. Overweight and smoking were directly and significantly associated with GC risk.

Conclusions:

During the study period, GC has decreased in Iran. Nevertheless, GC risk was generally high in Northern and Northwestern provinces of Iran. Different health policies according to GC risk and trend are required for each province. Improvements in screening and education programs and conducting further epidemiological studies could help to reduce the incidence of GC in high risk provinces.

Time trend analysis of breast cancer in Iran and its six topographical regions: a population-based study

Breast cancer is the most common cancer among women, and in 2002 it was expected that 636,000 new cases would occur in developed countries and 514,000 in developing countries. Although the incidence rate of this cancer in Asian countries is lower than in Western countries, whereas the incidence trend increasing rapidly in Asia. Using the data from the Cancer Registry System, this study was carried out to investigate the incidence trend during 2000-2005 in Iran and its six geographical areas. The incidence rates were standardized according to age-sex groups by Excel directly and confidence intervals is calculated for the point estimations by Stata11. The trends were analyzed separately based on gender, age groups for different provinces by Poisson regression in Stata11. The age standardized incidence rate in 2000 was 0.1 and 3.4 per 100,000 in males and females, respectively, reaching 0.5 and 16.7 per 100,000 in 2005. The incidence trends in all geographical areas of the country were increased despite the difference in the slopes. The sex ratio of male to female was 31.6 and the mean age of the patients was 49.4 (±12.6) years. The incidence of breast cancer in Iran was lower than the European and Asian countries but the trend is in rising. Although this increase is due to the increase in the prevalence of risk factors among Iranian population. Improvement in the coverage of the cancer registry system as well as the screening programs are important factors for these changes.

Cancer trends in a province of Southwest of Iran, 2003-2016

Background:

Awareness of the trends of cancer incidence in each geographic region is an important. The aim of present study was to determine the incidence trends of cancer in Chaharmahal and Bakhtiari (Ch and B) province in Southwest of Iran.

Materials and Methods:

In this secondary data analysis, retrospective existing data were used from cancer registry reports in Ch and B in Southwest of Iran in 2003–2016. Data on epidemiologic trend were analyzed using Joinpoint software package and annual percentage change (APC) with 95% confidence interval (95% CI) was computed.

Results:

Age-standardized incidence rate per 100,000 persons in the province in 2003 was 31.74 that increased to 147.14 in 2016. APC during 2003–2016 was 12.58% (CI: 9.3–16) and significant, which was 10.22% (7.4–13.1) and 14.47% (10.2–18.9) in men and women, respectively. Incidence of the stomach, breast, colorectal, thyroid, lymph node, and ovarian cancers is increasing and the highest incidence was observed in two age groups of 25–34 and 55–64 years.

Conclusion:

In general, cancers are of increasing trend. Surveillance and monitoring the incidence of cancer and studying the causes of environmental or genetic in the cancer changes can help for cancer prevention and control.

Postoperative cure in Iranian patients with gastric cancer: estimating the crude conditional probability in a relative survival setting in the presence of competing risks

Background

Following treatment, cancer patients may be clinically cured. However, they may die for reasons other than cancer, called competing risks.

Objective

To estimate postoperative cure while considering the competing risks in Iranian patients with gastric cancer.

Method

Data were obtained from the Cancer Institute of Imam Hospital in Tehran. The analysis was conducted within the framework of relative survival by fitting the data to a flexible parametric cure model, taking into account the competing risks using general population data by adjusting for age, sex, and year of diagnosis.

Results

Of the 326 patients (224 male and 102 female) whose data were included, 235 deaths (72.1%) occurred during the follow-up period. The probability of conditional cure in terms of crude ratios of dying from causes other than gastric cancer in the surviving patients increased with the passage of time, and the slope of excess mortality approached almost 0 after 7 years. The estimated cure ratios showed a variation from 69% for 50-year-old men with diagnosis at early stages (I and II) to 3% for 80-year-old women with diagnosis at stage IV.

Conclusion

The ratio of patients in Iran who were estimated to die from cancer reduced significantly with the passage of time following the diagnosis, and the statistical cure point was estimated to be 7 years after diagnosis. However, aging was shown to be inversely associated. Although the same trend was observed in both sexes, we showed that men were statistically more likely to reach the cure point.

HER-2/neu gene amplification in gastric adenocarcinoma and its relationship with clinical and pathological findings

Background

Amplification of the HER-2/neu oncogene influences the progression of gastric cancer, its prognosis, and therapy. A precise examination of HER-2/neu-amplified tumor tissue is essential for managing disease and prescribing the appropriate treatment. This study aimed to investigate the status of HER-2/neu gene in the gastric cancer samples and its relationship with clinical and pathological information.

Methods

In this study on 80 paraffin-embedded tissue samples from patients with gastric adenocarcinoma [2006-2011], DNA was extracted to quantify the gene expression levels of HER-2 using a polymerase chain reaction (PCR) method. Data were statistically analyzed by chi-square test using SPSS16.0 software.

Results

PCR results indicated that HER-2/neu gene amplifications occurred in 58 of the 80 samples (72.5%). HER-2/neu gene expression was not significantly related to age and sex, but the larger tumor size and the more advanced stage were significantly associated with HER-2/neu overexpression.

Conclusions

The data show the HER-2/neu gene is more amplified in stage 4 of gastric cancer with a larger size of mass. Older age and male sex also appear to be more associated with HER-2/neu gene expression.

Trends in gastrointestinal cancer incidence in Iran, 2001-2010: a joinpoint analysis

OBJECTIVES

The main purpose of this study was to evaluate changes in the time trends of stomach, colorectal, and esophageal cancer during the past decade in Iran.

METHODS

Cancer incidence data for the years 2001 to 2010 were obtained from the cancer registration of the Ministry of Health. All incidence rates were directly age-standardized to the world standard population. In order to identified significant changes in time trends, we performed a joinpoint analysis. The annual percent change (APC) for each segment of the trends was then calculated.

RESULTS

The incidence of stomach cancer increased from 4.18 and 2.41 per 100,000 population in men and women, respectively, in 2001 to 17.06 (APC, 16.7%) and 8.85 (APC, 16.2%) per 100,000 population in 2010 for men and women, respectively. The corresponding values for colorectal cancer were 2.12 and 2.00 per 100,000 population for men and women, respectively, in 2001 and 11.28 (APC, 20.0%) and 10.33 (APC, 20.0%) per 100,000 in 2010. For esophageal cancer, the corresponding increase was from 3.25 and 2.10 per 100,000 population in 2001 to 5.57 (APC, 12.0%) and 5.62 (APC, 11.2%) per 100,000 population among men and women, respectively. The incidence increased most rapidly for stomach cancer in men and women aged 80 years and older (APC, 23.7% for men; APC, 18.6% for women), for colorectal cancer in men aged 60 to 69 years (APC, 24.2%) and in women aged 50 to 59 years (APC, 25.1%), and for esophageal cancer in men and women aged 80 years and older (APC, 17.5% for men; APC,15.3% for women) over the period of the study.

CONCLUSIONS

The incidence of gastrointestinal cancer significantly increased during the past decade. Therefore, monitoring the trends of cancer incidence can assist efforts for cancer prevention and control.

Accuracy of endoscopic ultrasonography for determination of tumor invasion depth in gastric cancer

BACKGROUND

Gastric cancer (GC) is one the common lethal cancers in Iran. Detection of GC in the early stages would assesses to improve the survival of patients. In this study, we attempt to evaluate the accuracy of EUS in detection depth of invasion of GC among Iranian Patients.

MATERIALS AND METHODS

This study is a retrospective study of patients with pathologically confirmed GC. They underwent EUS before initiating the treatment. The accuracy of EUS and agreement between the two methods was evaluated by comparing pre treatment EUS finding with post operative histopathological results.

RESULTS

The overall accuracy of EUS for T and N staging was 67.9% and 75.47, respectively. Underestimation and overestimation was seen in 22 (14.2%) and 40 (25.6%) respectively. The EUS was more accurate in large tumors and the tumors located in the middle and lower parts of the stomach. The EUS was more sensitive in T3 staging. The values of weighted Kappa from the T and N staging were 0.53 and 0.66, respectively.

CONCLUSIONS

EUS is a useful modality for evaluating the depth of invasion of GC. The accuracy of EUS was higher if the tumor was located in the lower parts of the stomach and the size of the tumor was more than 3 cm. Therefore, judgments made upon other criteria evaluated in this study need to be reconsidered.

Promyelocytic Leukemia (PML) Gene Mutations may not Contribute to Gastric Adenocarcinoma Development

Gastric cancer is the second most common cause of cancer death worldwide. Environmental as well as genetic factors have been shown to be involved in its genesis. Among genetic factors, loss of function of a tumor suppressive gene named promyelocytic leukemia (PML) has been demonstrated in gastric cancer. In order to cast light in the mechanism by which PML protein is under-expressed in gastric cancer cells, we analyzed all exons and intron-exon boundaries of PML gene in 50 formalin-fixed paraffin-embedded tissue blocks from gastric carcinoma tumors by means of PCR-SSCP and CSGE, with direct sequencing of abnormally shifted bands. We found a novel sequence variant of unknown significance localized in intron 5 in 3 samples (c.1398+84delA). We did not detect any deleterious mutations of the PML gene. This study shows that PML mutations may not contribute to gastric adenocarcinoma development. Post-translational modifications or protein degradation might be mechanisms by which PML is not expressed in gastric tumors.

Epidemiology characteristics and trends of incidence and morphology of stomach cancer in Iran

BACKGROUND

Stomach cancer is the fourth most common cancer and the second leading cause of cancer- related death through the world. It is predicted that the number of new cancer cases will be more than 15 million cases by 2020. Regarding the lack of studies on this topic in the country, we have thoroughly examined the patho-epidemiology of stomach cancer in Iran.

MATERIALS AND METHODS

In this cross- sectional study data were collected retrospectively reviewing all new stomach cancer patients in Cancer Registry Center report of health deputy for Iran during a 6-year period (2003-2008). The study also examined the morphology of common stomach cancers. Trends in incidence and morphology underwent joinpoint regression analysis.

RESULTS

During the six-year period, a total of 35,171 cases of stomach cancer were registered. Average age standardized rate for females and males were equal to 7.1 and 15.1 per 100,000 persons, respectively. Most common histological type was adenocarcinoma, NOS with 21,980 cases (62.50%). The annual percentage change (APC) in age-standardized incidence rate (per 100,000) was increase in both females and males at 11.1 (CI: 4.3 to 18.3) and 9.2 (CI: 5.2 to 13.4), respectively.

CONCLUSIONS

According to our results, the incidence of gastric cancer is increasing in Iran, so further epidemiological studies into the etiology and early detection are essential.

Vitamin D intake, serum Vitamin D levels, and risk of gastric cancer: A systematic review and meta-analysis

Background:

We are aware of no systematic review or meta-analysis of published findings about the association between Vitamin D status and risk of gastric cancer (GC). We systematically reviewed the current evidence on the association between Vitamin D intake as well as serum 25-hydroxy Vitamin D (25(OH)D) levels and risk of GC.

Materials and Methods:

Published evidence in this area was searched to August 2014 through the use of ISI Web of Science, Scopus, PubMed/Medline, Ovid Database, EMBASE, and Google Scholar for relevant articles by cross-referencing. Seven articles had reported odds ratios (ORs) or relative risks (RR) as their effect size; four papers had reported the ORs between Vitamin D intake and GC; and three papers had reported the association between serum 25(OH)D and risk of GC.

Results:

Pooled effect size for comparison of highest versus lowest intakes of Vitamin D was 1.09 (95% confidence interval [CI]: 0.94, 1.25; P = 0.26) indicating no significant association between Vitamin D intake and risk of GC. We failed to find a significant association between serum Vitamin D levels and risk of GC (OR: 0.92; 95% CI: 0.74-1.14; P = 0.429). Among men, the pooled effect size or highest versus lowest category of serum Vitamin D levels was 0.92 (95% CI: 0.71, 1.18, P = 0.49). The corresponding figures in women were 1.04 and 95% CI: 0.74-1.47 (P = 0.80).

Conclusion:

We found no evidence for the significant association between Vitamin D status and risk of GC. However, due to limited data in this field, further studies are required to reach a definite conclusion.

Characteristics of gastric cancer in Asia

Gastric cancer (GC) is the fourth most common cancer in the world with more than 70% of cases occur in the developing world. More than 50% of cases occur in Eastern Asia. GC is the second leading cause of cancer death in both sexes worldwide. In Asia, GC is the third most common cancer after breast and lung and is the second most common cause of cancer death after lung cancer. Although the incidence and mortality rates are slowly declining in many countries of Asia, GC still remains a significant public health problem. The incidence and mortality varies according to the geographic area in Asia. These variations are closely related to the prevalence of GC risk factors; especially Helicobacter pylori (H. pylori) and its molecular virulent characteristics. The gradual and consistent improvements in socioeconomic conditions in Asia have lowered the H. pylori seroprevalence rates leading to a reduction in the GC incidence. However, GC remains a significant public health and an economic burden in Asia. There has been no recent systemic review of GC incidence, mortality, and H. pylori molecular epidemiology in Asia. The aim of this report is to review the GC incidence, mortality, and linkage to H. pylori in Asia.

Association between promoter methylation and expression of thyroid hormone receptor beta (THRβ) gene in patients with gastric cancer in an Iranian population

BACKGROUND AND AIM

There is evidence that gastric cancer patients suffer from thyroid disorders. However, the relationship between thyroid receptor (TR) expression and gastric cancer remains unknown. The aim of this study was to evaluate the status of promoter methylation and expression of the thyroid hormone receptor beta (THRβ) gene in gastric cancer patients in an Iranian population.

METHODS

Analysis of THRβ promoter methylation was performed on 85 pairs of formalin-fixed, paraffin-embedded (FFPE) tissue samples as cases and controls via methylation-specific polymerase chain reaction (PCR [MSP]). The samples were obtained from tumors and surrounding healthy tissues from resected gastric cancers. The expression assay was also performed with 25 FFPE tissue pairs (tumor and surrounding healthy tissues of the same individual) using real-time PCR.

RESULTS

The results of the present study show that there is a statistically significant difference between tumor and adjacent normal tissues regarding promoter methylation status and THRβ expression (P = 0.04 and P = 0.036, respectively).

CONCLUSION

Therefore, promoter methylation of THRβ may be involved in the development of gastric cancer.

Trend analysis of gastrointestinal cancer incidences in Guilan province: comparing rates over 15 years

BACKGROUND

Cancers of gastric and esophagus are the most frequent gastrointestinal (GI) tract cancers in Iran. This study aimed to analyze time trends of GI tract cancers in Guilan province by gender and age to provide solid scientific evidence for cancer prevention and control.

MATERIALS AND METHODS

The data were obtained from the Guilan Cancer Registry System and Guilan Provincial Health Center, over the 15 year period between 1997 and 2011. Crude incidence and age standardized (AS)incidence rates were calculated and annual percent change was estimated by Joinpoint software for long term trend analysis.

RESULTS

During the study period, 8,332 cases of GI malignances with a male to female ratio of 1:1.73 were registered in Guilan province. The AS rates for esophageal, gastric, colon and rectal cancers were 5.97, 14.5, 7.59 and 3.58 per 105 respectively. While the trend was declining and relatively constant for esophageal and gastric cancer, respectively, the incidence trend for colon and rectal cancers was of increase over the period of the study.

CONCLUSIONS

The results indicated that the incidence of GI cancers was relatively low in Guilan province compared to neighboring provinces. An effective cancer control program including prevention measures, early detection and effective treatment needs to be implemented to reduce cancer morbidity and mortality.

Estimation of the gastric cancer incidence in Tehran by two- source capture-recapture

INTRODUCTION

Capture-recapture methods have been suggested for reducing costs of disease registration as well as reducing bias in incidence estimations. This study aimed to estimate the gastric cancer incidence in theTehran metropolis population during 2002-2006.

MATERIALS AND METHODS

We investigated new cases of gastric cancer reported by three sources; death certificates, pathology reports, and medical records to Tehran population-based cancer registry during 2002-2006. G2 statistics and the two-source capture-recapture method were used to select the best-fitted log-linear model and to estimate incidence, respectively. EXCEL software version 2007 and SPSS software version 16 were used for this research.

RESULTS

The number of reported cases was 4,463, with an average age of 68.5 (±12.9) years. We found the model that combined two sources of data including pathology reports and medical records and furthermore complemented by death certificates as the best model. The reported and the estimated incidences were 11.0 and 27.1 per 100,000 respectively.

CONCLUSIONS

The incidence estimated by two- source capture-recapture method is about three times higher than the incidence reported by the sources under investigation. It is recommended to move towards the implementation of population-based cancer registration using various sources of data collection to achieve more accurate data.

Characteristics of gastric cancer in Asia

Gastric cancer (GC) is the fourth most common cancer in the world with more than 70% of cases occur in the developing world. More than 50% of cases occur in Eastern Asia. GC is the second leading cause of cancer death in both sexes worldwide. In Asia, GC is the third most common cancer after breast and lung and is the second most common cause of cancer death after lung cancer. Although the incidence and mortality rates are slowly declining in many countries of Asia, GC still remains a significant public health problem. The incidence and mortality varies according to the geographic area in Asia. These variations are closely related to the prevalence of GC risk factors; especially Helicobacter pylori (H. pylori) and its molecular virulent characteristics. The gradual and consistent improvements in socioeconomic conditions in Asia have lowered the H. pylori seroprevalence rates leading to a reduction in the GC incidence. However, GC remains a significant public health and an economic burden in Asia. There has been no recent systemic review of GC incidence, mortality, and H. pylori molecular epidemiology in Asia. The aim of this report is to review the GC incidence, mortality, and linkage to H. pylori in Asia.

Incidence trends of colorectal cancer in the West of Iran during 2000-2005

BACKGROUND

Colorectal cancer is a main leading cause of cancer death in western countries. Although many studies have been conducted on incidence trends all over the world in recent years, information regarding changes in incidence of colorectal cancer in Iran is insufficient. The present study of colorectal cancer in the west of Iran during recent years was therefore performed.

MATERIALS AND METHODS

The registered data for colorectal cancer cases in National Cancer Registry System were extracted from the Ministry of Health and Medical Education, Center for Disease Control and Management. The codes from 18-21 among cancers were selected for colon and rectum cancers. Incidence rates were standardized directly using WHO population. The significance of incidence rate trends during 2000-2005 was tested through Poisson regression.

RESULTS

762 cases of colorectal cancer were observed during 6 years in this region, with a gender ratio of men to women of 1.2. It increased from 65 cases in 2000 to 213 cases in 2005 or from 1.5 per100,000 per persons per year to 4.8. Significant increasing trends were evident in Kermanshah and Hamadan provinces; however, change did not reach significance in Ilam and Kurdistan provinces.

CONCLUSIONS

Colorectal cancer has an increasing trend in the west of Iran. Although it seems that the increasing rate of colorectal cancer is due to increasing of cancer risk factors, some proportion may be related to the improvement of surveillance systems in Iran.

Gastrointestinal, liver and biliary tract pathology: a histopathological and epidemiological perspective from Pakistan with a review of the literature

AIM

To present an epidemiological and histological perspective of diseases of the gastrointestinal tract (including liver and biliary tract) at the Section of Histopathology, Department of Pathology, AKUH, Karachi, Pakistan.

MATERIALS AND METHODS

All consecutive endoscopic biopsies and resections between October 1 and December 31, 2012 were included.

RESULTS

A total of 2,323 cases were included. Carcinoma was overwhelmingly the commonest diagnosis on esophageal biopsies (69.1%); chronic helicobacter gastritis (45.6%) followed by adenocarcinoma (23.5%) were the commonest diagnoses on gastric biopsies; adenocarcinoma (27.3%) followed by ulcerative colitis (13.1%) were the commonest diagnoses on colonic biopsies; acute appendicitis (59.1%) was the commonest diagnosis on appendicectomy specimens; chronic viral hepatitis (44.8%) followed by hepatocellular carcinoma (23.4%) were the commonest diagnoses on liver biopsies; chronic cholecystitis was the commonest diagnosis (over 89%) on cholecystectomy specimens.

CONCLUSIONS

Squamous cell carcinoma comprised 88.8% of esophageal cancers. About 67% were in the lower third and 56.5% were moderately differentiated; mean ages 49.8 years for females and 55.8 years for males; 66% cases were from South West Pakistan. Over 67% patients with gastric adenocarcinoma were males; mean ages 59 and 44 years in males and females respectively, about 74% gastric carcinomas were poorly differentiated; and 62.2% were located in the antropyloric region. About 63% patients with colorectal adenocarcinoma were males; mean ages 46.1 and 50.5 years for males and females respectively; tumor grade was moderately differentiated in 54%; over 80% were located in the left colon. In 21.2% appendicectomies, no acute inflammation was found. Acute appendicitis was most common in young people. Hepatitis C (66.3%) was more common than hepatitis B (33.7%); about 78% cases of hepatocellular carcinoma occurred in males; females comprised 76.7% patients with chronic cholecystitis; and 77.8% patients with gall bladder carcinoma. All resection specimens showed advanced cancers. Most cancers occurred after the age of 50 years.