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Systematic review and meta-analysis of esophageal cancer in Africa:Epidemiology, risk factors, management and outcomes

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World Journal of Gastroenterology 2019年第31期25卷 4512-4533页

作者： Akwi W Asombang nathaniel chishinga Alick Nkhoma Jackson Chipaila Bright Nsokolo Martha Manda-Mapalo Joao Filipe G Montiero Lewis Banda Kulwinder S Dua Division of Gastroenterology/Hepatology Warren Alpert Medical School of Brown UniversityProvidenceRI 02903United States Department for HIV Elimination Fulton County GovernmentAtlantaGA 30303United States Department of Gastroenterology Royal Stoke University HospitalUniversity Hospitals of North Midlands NHS TrustStaffordshire ST4 6QGUnited Kingdom Department of Surgery University Teaching Hospital-Adult HospitalLusaka 10101Zambia Department of Medicine Levy Mwanawasa University Teaching HospitalTropical Gastroenterology and Nutrition Group(TROPGAN)Lusaka 10101Zambia Department of Medicine The University of New MexicoAlbuquerqueNM 87106United States Department of Medicine Brown UniversityProvidenceRI 02903United States Hematology/Oncology Cancer Disease HospitalLusaka 10101Zambia Department of Medicine and Pediatrics Medical College of WisconsinMilwaukeeWI 53226United States

BACKGROUND Esophageal cancer(EC)is associated with a poor prognosis,particularly so in Africa where an alarmingly high mortality to incidence ratio prevails for this *** To provide further understanding of EC in the context of the unique cultural and genetic diversity,and socio-economic challenges faced on the African *** We performed a systematic review of studies from Africa to obtain data on epidemiology,risk factors,management and outcomes of EC.A non-systematic review was used to obtain incidence data from the International Agency for Research on Cancer,and the Cancer in Sub-Saharan *** searched EMBASE,PubMed,Web of Science,and Cochrane Central from inception to March 2019 and reviewed the list of articles *** effects metaanalyses were used to assess heterogeneity between studies and to obtain odds ratio(OR)of the associations between EC and risk factors;and incidence rate ratios for EC between sexes with their respective 95%confidence intervals(CI).RESULTS The incidence of EC is higher in males than females,except in North Africa where it is similar for both *** highest age-standardized rate is from Malawi(30.3 and 19.4 cases/year/100000 population for males and females,respectively)followed by Kenya(28.7 cases/year/100000 population for both sexes).The incidence of EC rises sharply after the age of 40 years and reaches a peak at 75 years ***-analysis shows a strong association with tobacco(OR 3.15,95%CI:2.83-3.50).There was significant heterogeneity between studies on alcohol consumption(OR 2.28,95%CI:1.94-2.65)and on low socioeconomic status(OR 139,95%CI:1.25-1.54)as risk factors,but these could also contribute to increasing the incidence of *** best treatment outcomes were with esophagectomy with survival rates of 76.6%at 3 years,and chemo-radiotherapy with an overall combined survival time of 267.50 *** Africa has high incidence and mortality rates of EC,with preventable and nonmodifiable ris

关键词： Esophageal cancer in Africa Esophageal squamous cell carcinoma Cancer in Africa Systematic review

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