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Global burden prediction of gastric cancer during demographic transition from 2020 to 2040

Chinese Medical Journal 2023年第4期136卷 397-406页

作者： Chao Yan Fei Shan xiangji ying Ziyu Li Key laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing) Gastrointestinal Cancer CenterPeking University Cancer Hospital&InstituteBeijing 100142China

Background: Despite the decline in the incidence and mortality rates of gastric cancer (GC), the impact of demographic transition on the global burden of GC remains unclear. The current study aimed to estimate the global disease burden through 2040 by age, sex, and region. Methods: GC data for incident cases and deaths by age group and sex were taken from The Global Cancer Observatory (GLOBOCAN) 2020. The incidence and mortality rates were predicted through 2040 by fitting a linear regression model over the most recent trend period with the Cancer Incidence in Five Continents (CI5) data. Results: The global population will grow to 9.19 billion by 2040, accompanied by increasing population ageing. The incidence and mortality rates of GC will show a persistent decrease, with an annual percent change of -0.57% for males and -0.65% for females. East Asia and North America will have the highest and lowest age standardized rates, respectively. A slowdown in the growth of incident cases and deaths will be observed worldwide. The proportion of young and middle-aged individuals will decline, while the percentage of the elderly will increase, and the number of males will be almost twice the number of females. East Asia and high human development index (HDI) regions will be heavily burdened by GC. East Asia had 59.85% of the new cases and 56.23% of deaths in 2020;these will increase to 66.93% and 64.37% by 2040, respectively. The interaction between population growth, the change in ageing structure and the decline in incidence and mortality rates will lead to an increased burden of GC. Conclusions: Ageing and population growth will offset the decline in the incidence and mortality rate of GC, resulting in a substantial increase in the number of new cases and deaths. The age structure will continue to change, especially in high HDI regions, requiring more targeted prevention strategies in the future.

关键词： Aging Gastric cancer Stomach neoplasms Incidence Mortality Global burden of disease Population growth Population dynamics GLOBOCAN 2020

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Laparoscopic vs.open lower mediastinal lymphadenectomy for Siewert typeⅡ/Ⅲadenocarcinoma of esophagogastric junction:An exploratory,observational,prospective,IDEAL stage2b cohort study(CLASS-10 study)

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Chinese Journal of Cancer Research 2022年第4期34卷 406-414页

作者： Shuangxi Li xiangji ying Fei Shan Yongning Jia Zhemin Li Kan Xue Rulin Miao Yinkui Wang Zhaode Bu Xiangqian Su Ziyu Li Jiafu Ji Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing) Gastrointestinal Cancer CenterPeking University Cancer Hospital&InstituteBeijing 100142China

Objective:This study aims to verify the feasibility and efficacy of laparoscopic lower mediastinal lymphadenectomy for Siewert typeⅡ/Ⅲadenocarcinoma of esophagogastric junction(AEG).Setting:An exploratory,observational,prospective,cohort study will be carried out under the Idea,Development,Exploration,Assessment and Long-term Follow-up(IDEAL)framework(stage 2 b).Paritcipants:The study will recruit 1,036 patients with cases of locally advanced AEG(Siewert typeⅡ/Ⅲ,clinical stage cT2-4 aN0-3 M0),and 518 will be assigned to either the laparoscopy group or the open group.Interventions:Patients will receive lower mediastinal lymphadenectomy along with either total or proximal gastrectomy.Primary and secondary outcome measures:The primary endpoint is the number of lower mediastinal lymph nodes retrieved,and the secondary endpoints are the surgical safety and prognosis,including intraoperative and postoperative lower-mediastinal-lymphadenectomy-related morbidity and mortality,rate of rehospitalization,R0 resection rate,3-year local recurrence rate,and 3-year overall survival.Conclusions:The study will provide data for the guidance and development of surgical treatment strategies for AEG.Trial registration number:The study has been registered in ClinicalTrials.gov(No.NCT04443478).

关键词： Esophagogastric junction laparoscopy lymph node excision stomach neoplasms

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Associations of centralization with health care quality for gastric cancer patients receiving gastrectomy in China

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Chinese Journal of Cancer Research 2021年第6期33卷 659-670页

作者： Jiafu Ji Leiyu Shi xiangji ying Xinpu Lu Fei Shan Haibo Wang Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing) Center of Gastrointestinal CancerPeking University Cancer Hospital&InstituteBeijing 100142China Department of Health Policy and Management Johns Hopkins University Bloomberg School of Public HealthBaltimoreMD 21205USA Key Laboratory of Carcinogenesis and Translational Research(Ministry7 of Education/Beijing) Peking University Cancer Hospital&InstituteBeijing 100142China Clinical Trial Unit the First Affiliated Hospital of Sun Yat-sen UniversityGuangzhou 510080China

Objective:Limited evidence is available regarding the associations of centralization with gastric cancer patients’quality of care in high surgical volume settings.The current study aimed to explore the effects of hospital volume and the Herfindahl-Hirschman index(HHI)on in-hospital mortality,total cost,and length of stay for Chinese gastrectomy patients in a nationwide database.Methods:We extracted data on gastrectomy for gastric cancer from the Hospital Quality Monitoring System Database between 2013 and 2018.Hospital volume was divided into 4 quartiles:low(1-83 cases per year),medium(84-238 cases),high(239-579 cases),and very high(580-1,193 cases).The HHI was divided into 3 categories:highly concentrated(>2,500),moderately concentrated(1,500-2,500),and unconcentrated(<1,500).We used mixed-effects models to analyze the data while accounting for data clustering.Results:We analyzed 125,683 patients in 515 institutions.In the multivariable analyses,hospital volume was significantly associated with in-hospital mortality[medium vs.low:odds ratio(OR)=0.61,95%confidence interval(95%CI)=0.43-0.84,P=0.003;high:OR=0.57,95%CI=0.38-0.87,P=0.009;and very high:OR=0.33,95%CI=0.18-0.61,P<0.001)and length of stay(high vs.low:β=-0.036,95%CI=-0.071--0.002,P=0.039)but not with total cost.Hospitals located in unconcentrated provinces had higher in-hospital mortality(OR=1.52,95%CI=1.03-2.26,P=0.036)and longer lengths of stay(β=0.024,95%CI=0.001-0.047,P=0.041)than hospitals located in highly concentrated provinces.Conclusions:Centralization of gastrectomy,measured by hospital volume and the HHI,was associated with decreased in-hospital mortality and shortened length of stay without increasing total cost.These results support the strategy of centralizing gastrectomy in high-volume settings.

关键词： Centralization gastric cancer Herfindahl-Hirschman index hospital volume quality of care

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Gastric cancer: Epidemiology, risk factors and prevention strategies

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Chinese Journal of Cancer Research 2020年第6期32卷 695-704页

作者： Lei Yang xiangji ying Shuo Liu Guoqing Lyu Zekuan Xu Xi Zhang Huichao Li Qingyu Li Ning Wang Jiafu Ji Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing) Beijing Office for Cancer Prevention and ControlPeking University Cancer Hospital&InstituteBeijing 100142China Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing) Center of Gastrointestinal CancerPeking University Cancer Hospital&InstituteBeijing 100142China Department of Gastrointestinal Surgery Peking University Shenzhen HospitalShenzhen 518036China Department of General Surgery the First Affiliated Hospital of Nanjing Medical UniversityCollaborative Innovation Center for Cancer Personalized MedicineNanjing Medical UniversityNanjing 210029China

Gastric cancer(GC) is a global health problem, with more than 1 million people newly diagnosed with GC worldwide each year. GC is more prevalent in less developed countries than in more developed countries. About half of all GC cases worldwide occur in East Asia, notably China. Globally, overall incidence rates of GC are declining, which is potentially attributed to a decrease in Helicobacter pylori(H. pylori) infection and the use of refrigeration to preserve foods rather than salt. GC is a multifactorial disease, and its occurrence and development were impacted by environmental and genetic factors. H. pylori infection is the primary risk factor for GC, especially for non-cardia. The prognosis of GC is poor due to stages at the first diagnosis. The 5-year survival rate is less than 10% when patients are diagnosed at an advanced stage, but the rate is as high as 85% if patients are detected at an earlier stage. Endoscopic screening can potentially prevent GC by early diagnosis and early treatment and has been widely adopted in screening programs in East Asian countries, such as Japan and Korea. This review summarizes updated epidemiological aspects, risk factors, and prevention strategies of GC in recent years to help researchers determine the most effective intervention strategies for reducing risk of GC.

关键词： Gastric cancer epidemiology risk factor prevention strategy

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Oxaliplatin plus S-1 or capecitabine as neoadjuvant or adjuvant chemotherapy for locally advanced gastric cancer with D2lymphadenectomy: 5-year follow-up results of a phase II-III randomized trial

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Chinese Journal of Cancer Research 2018年第5期30卷 516-525页

作者： Kan Xue xiangji ying Zhaode Bu Aiwen Wu Zhongwu Li Lei Tang Lianhai Zhang Yan Zhang Ziyu Li Jiafu Ji Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) Gastrointestinal Cancer Center Beijing 100142 China Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) Department of Pathology Beijing 100142 China Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) Department of Radiology Peking University Cancer Hospital & Institute Beijing 100142 China

Objective： To compare the effect of neoadjuvant chemotherapy （NACT） with adjuvant chemotherapy （ACT） using oxaliplatin plus S-1 （sex） or capecitabine （CapeOX） on gastric cancer patients with D2 lymphadenectomy. Methods： This was a two-by-two factorial randomized phase Ⅱ-Ⅲ trial, and registered on ISRCTN registry （No. ISRCTN12206108）. Locally advanced gastric cancer patients were randomized to neoadjuvant sex, neoadjuvant CapeOX, adjuvant sex, or adjuvant CapeOX arms. Primary analysis was performed on an intention- to-treat （ITT） basis using overall survival （OS） as primary endpoint. Results： This trial started in September 2011 and closed in December 2012 with 100 patients enrolled. Treatment completion rate was 56%, 52%, 38% and 30% in the four arms, respectively. NACT group had fewer dropouts due to unacceptable toxicity （P=0.042）. Surgical complication rate did not differ by the four groups （P=0.986）. No survival signifcant difference was found comparing NACT with ACT （P=0.664; 5-year-OS： 70% vs. 74% respectively）, nor between the sex and CapeOX groups （P=0.252; 5-year-OS： 78% vs. 66% respectively）. Subgroup analysis showed sex significantly improved survival in patents with diffuse type （P=0.048）. Conclusions： No significant survival difference was found between NACT and ACT. sex and CapeOX had good safety and efficacy as neoadjuvant regimens. Diffuse type patients may survive longer due to sex.

关键词： SOX CapeOX neoadjuvant chemotherapy adjuvant chemotherapy gastric cancer

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Anatomical variation of infra-pyloric artery origination： A prospective multicenter observational study (IPA-Origin)

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Chinese Journal of Cancer Research 2018年第5期30卷 500-507页

作者： Rulin Miao Jianjun Qu Zhengrong Li Daguang Wang Jiang Yu Weidong Zang Yong Li Fenglin Liu Jian Zhang Wu Song Kai Ye Su Yan Wei Wang Shuangyi Ren Lu Zang Changqing Jing Li Zhang Kuan Wang Weihua Fu Lin Fan Bin Liang Gang Zhao Jun Cai Li Yang Jiaming Zhu Jun You Kun Yang Qingxing Huang Zhaojian Niu Ning Ning Xingfeng Qiu Gang Ji Feng Liang Hua Huang Chao Gao Fei Shan Shuangxi Li Yongning Jia Lianhai Zhang xiangji ying Yan Zhang Zhaode Bu Xiangqian Su Gang Zhao Ziyu Li Jiafu Ji Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing) Gastrointestinal Cancer Center Peking University Cancer Hospital & Institute Beijing 100142 China Department of Surgical Oncology Weifang People's Hospital Weifang 261000 China Department of General Surgery the First Affiliated Hospital of Nanchang University Nanchang 330006 China Department of Gastrointestinal Surgery the First Hospital of Jilin University Changehun 130021 China Department of General Surgery Nanfang Hospital Southern Medical University Guangzhou 510515 China Department of Gastrointestinal Cancer Surgery Fujian Provincial Cancer Hospital Fuzhou 350014 China Department of General Surgery Guangdong General Hospital Guangdong Academy of Medical Sciences Guangzhou 510080 China Department of General Surgery Zhongshan Hospital Fudan University Shanghai 200032 China Department of Gastrointestinal Surgery Hangzhou First People's Hospital Hangzhou 310006 China Department of Gastrointestinal Surgery the First Affiliated Hospital Sun Yat-sen University Guangzhou 510080 China Department of Surgical Oncology the Second Affiliated Hospital of Fujian Medical University Quanzhou 362000 China Department of Surgical Oncology Affiliated Hospital of Qinghai University Xining 810001 China Department of Gastrointestinal Surgery Guangdong Provincial Hospital of Chinese Medicine Guangzhou 510120 China Department of General Surgery the Second Hospital of Dalian Medical University Dalian 116023 China Department of General Surgery Shanghai Ruijin Hospital Shanghai Jiaotong University School of Medicine Shanghai 200025 China Department of Gastrointestinal Surgery Shandong Provincial Hospital Affiliated to Shandong University Jinan 250021 China Department of Gastrointestinal Surgery Harbin Medical University Cancer Hospital Harbin 150081 China Department of General Surgery Tianjin Medical University General Hospital Tianjin 300052 China Department of General Surgery the Firs

Objective： Infra-pyloric artery （IPA） is an important anatomical landmark in treatment of gastric cancer and is the key vessel for pylorus-preserving gastrectomy and subgroup of infra-pyloric lymph nodes. However, its anatomical variation is not thoroughly understood. Our study aimed to clarify the origination of the IPA. Methods： We did this prospective, multicenter, open-label, observational study at gastric surgery departments of 34 hospitals in China. Gastric cancer patients aged 18 years or older and scheduled to undergo elective total or distal gastrectomy were assigned. During the surgery, IPA dissecting and exposing the origination point with photographs or video clips were required. The primary outcome was the origination of the IPA. Analysis of variance, χ2 tests and Fisher＇s tests were used to analyze the differences between groups. The study is registered at Clinicaltrials.gov （No. NCT03071237）. Results： Between May 8 and July 31, 2017, 429 patients were assigned for the study, and 419 （97.7%） patients had the IPA dissected and recorded through photograph or video and were included in the primary outcome analysis. The median age was 62 years old, and 73.7% were male. Among the patients, 78.5% received laparoscopic surgery. Single IPA origination was identified in 398 （95.0%） patients, including gastroduodenal artery （GDA） in 154 （36.8%） patients, anterior superior pancreaticoduodenal artery （ASPDA） in 130 （31.0%） patients, and right gastroepiploic artery （RGEA） in 114 （27.2%） patients. Fifteen （3.6%） patients were identified with multiple IPA and 6 （1.4%） patients were identified as IPA absence. The differences in the distribution of surgical approach （P=0.003） and geographic area （P=0.030） were statistically significant. No difference was shown in sex, age, gastrectomy type, tumor location, and clinical T, N and M stage. Conclusions： Our study found that the IPA originates from GDA, ASPDA and RGEA in similar proportions. Laparoscopic surgery may be more helpful in dissection of the IPA than open surg

关键词： Infra-pyloric artery origination anatomy gastric cancer

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基于倾向性评分匹配的食管胃结合部腺癌不同综合治疗模式的单中心回顾性研究

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中华外科杂志 2022年第9期60卷 846-852页

作者：戴红梅王胤奎应项吉李双喜陕飞贾永宁薛侃苗儒林李浙民李子禹季加孚北京大学肿瘤医院暨北京市肿瘤防治研究所胃肠肿瘤中心恶性肿瘤发病机制及转化研究教育部重点实验室北京100142

目的比较不同综合治疗模式对食管胃结合部腺癌患者术后病理学分期及远期生存的影响。方法回顾性分析2012年1月1日至2017年12月31日北京大学肿瘤医院胃肠肿瘤中心收治的219例食管胃结合部腺癌手术患者的临床和病理学资料,根据围手术期综... 详细信息

目的比较不同综合治疗模式对食管胃结合部腺癌患者术后病理学分期及远期生存的影响。方法回顾性分析2012年1月1日至2017年12月31日北京大学肿瘤医院胃肠肿瘤中心收治的219例食管胃结合部腺癌手术患者的临床和病理学资料,根据围手术期综合治疗模式分为直接手术组、新辅助化疗组和新辅助放化疗组。使用R语言的“Trimatch”包,以性别、年龄、合并症、体重指数、临床T分期、临床N分期及Siewert分型为协变量对3组进行匹配,卡钳值取0.2;每组29例患者共87例纳入分析。男性82例,女性5例,中位年龄63岁(范围:38~76岁)。采用方差分析、Wilcoxon秩和检验或χ^(2)检验比较各组术后病理学分期,两两比较采用Mann-Whitney U检验或χ^(2)检验;采用Kaplan-Meier法绘制生存曲线,Log-rank检验进行组间比较。结果直接手术组脉管癌栓的比例为72.4%(21/29),高于新辅助化疗组的37.9%(11/29)(χ^(2)=6.971,P=0.008)和新辅助放化疗组的6.9%(2/29)(χ^(2)=26.696,P<0.01)。新辅助放化疗组和新辅助化疗组病理T3~4期的比例分别为55.2%(16/29)和62.1%(18/29),低于直接手术组的93.1%(27/29)(χ^(2)=10.881,P=0.001;χ^(2)=8.031,P=0.005)。直接手术组病理N(+)期比例为86.2%(25/29),高于新辅助化疗组的55.2%(16/29)(χ^(2)=6.740,P=0.009)和新辅助放化疗组的31.0%(9/29)(χ^(2)=18.196,P<0.01)。直接手术组、新辅助化疗组和新辅助放化疗组的5年总体生存率分别为62.1%、68.6%和41.4%(χ^(2)=4.976,P=0.083),5年无进展生存率分别为61.7%、65.1%和41.1%(χ^(2)=4.332,P=0.115)。结论新辅助化疗和新辅助放化疗可降低食管胃结合部腺癌患者T3~4期、N+期和脉管癌栓比例,达到肿瘤局部控制。三种治疗模式的预后无明显差别。

关键词：食管胃接合处腺癌胃肿瘤新辅助化疗新辅助放化疗外科手术预后

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腹部CT增强扫描与超声胃镜应用于胃癌新辅助化疗后分期准确性的比较

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中华外科杂志 2020年第8期58卷 614-618页

作者：王胤奎陕飞应项吉张燕肖琪严唐磊吴齐李子禹季加孚北京大学肿瘤医院暨北京市肿瘤防治研究所胃肠肿瘤中心一病区恶性肿瘤发病机制及转化研究教育部重点实验室 100142 北京大学肿瘤医院暨北京市肿瘤防治研究所影像科恶性肿瘤发病机制及转化研究教育部重点实验室 100142 北京大学肿瘤医院暨北京市肿瘤防治研究所内镜中心恶性肿瘤发病机制及转化研究教育部重点实验室 100142

目的比较腹部CT增强扫描与超声胃镜应用于胃癌新辅助化疗后分期的准确性。方法回顾性分析2015年4月23日至2017年11月23日86例于北京大学肿瘤医院行新辅助化疗后利用腹部CT增强扫描和超声胃镜进行肿瘤临床分期的进展期胃癌患者的资料。男... 详细信息

目的比较腹部CT增强扫描与超声胃镜应用于胃癌新辅助化疗后分期的准确性。方法回顾性分析2015年4月23日至2017年11月23日86例于北京大学肿瘤医院行新辅助化疗后利用腹部CT增强扫描和超声胃镜进行肿瘤临床分期的进展期胃癌患者的资料。男性60例,女性26例,年龄(57.8±9.7)岁(范围:32~76岁)。以新辅助化疗后的病理学分期作为金标准,比较两者诊断新辅助化疗后临床T分期和N分期的准确性。采用多级受试者工作特征曲线下面积(M-AUC)计算两者的诊断效能,采用McNemar检验比较两者的灵敏度。结果新辅助化疗后腹部CT增强扫描诊断T分期(CT-ycT分期)的M-AUC为0.614,超声胃镜诊断T分期(EUS-ycT分期)的M-AUC为0.704。胃中部和下部癌CT-ycT分期的M-AUC分别为0.599和0.613,EUS-ycT分期的M-AUC分别为0.558和0.709。胃小弯和非胃小弯肿瘤CT-ycT分期的M-AUC分别为0.630和0.607,EUS-ycT分期的M-AUC分别为0.616和0.749。对于CT-ycT1期至CT-ycT4期患者,其CT-ycT分期和EUS-ycT分期的灵敏度分别为2/18、2/15、52.8%(19/36)、8/13比0、4/15、55.6%(20/36)、7/13,差异均无统计学意义(χ2=2.00,P=0.157;χ2=2.00,P=0.157;χ2=0.08,P=0.782;χ2=0.33,P=0.564)。CT-ycN分期和EUS-ycN分期的M-AUC分别为0.654和0.553。对于CT-ycN0患者,CT-ycN分期与EUS-ycN分期的灵敏度的差异有统计学意义[12.7%(7/55)比5.5%(3/55),χ2=4.00,P=0.046];对于CT-ycN1、N2、N3患者,CT-ycN分期与EUS-ycN分期的灵敏度差异均无统计学意义(2/19、1/10、0比1/19、1/10、0;χ2=1.00,P=0.317;后两者P值不可估)。结论腹部CT增强扫描与超声胃镜在胃癌新辅助化疗后分期的准确性方面无明显差异。考虑到超声胃镜的不耐受性,不推荐常规行超声胃镜检查。

关键词：胃肿瘤抗肿瘤联合化疗方案胃镜检查体层摄影术,X线计算机肿瘤分期

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胃肠肿瘤医疗大数据库的机遇与挑战

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中华消化外科杂志 2019年第3期18卷 199-202页

作者：季加孚何琦非王晓云于文博苗儒林应项吉卢新璞北京大学肿瘤医院暨北京市肿瘤防治研究所胃肠肿瘤中心恶性肿瘤发病机制及转化研究教育部重点实验室 100142 医渡云(北京)技术有限公司 100101

随着信息化技术的发展,大数据时代的到来,国家出台了多部政策纲要指导包括医疗在内的多个行业大数据应用和发展。笔者介绍了医疗大数据发展的时代背景和重要意义,回顾总结了国外大数据平台的特点,对医疗大数据平台的管理和应用进行阐述... 详细信息

随着信息化技术的发展,大数据时代的到来,国家出台了多部政策纲要指导包括医疗在内的多个行业大数据应用和发展。笔者介绍了医疗大数据发展的时代背景和重要意义,回顾总结了国外大数据平台的特点,对医疗大数据平台的管理和应用进行阐述,对胃肠肿瘤乃至整个医疗行业的大数据发展进行展望和憧憬。

关键词：胃肿瘤肠肿瘤医疗大数据精准医疗数据库

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新型冠状病毒肺炎疫情期间胃癌患者的院外管理策略

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中华消化外科杂志 2020年第3期19卷 239-243页

作者：薛侃李子禹吴舟桥李双喜贾永宁苗儒林李浙民闫超李沈王胤奎应项吉张燕季加孚恶性肿瘤发病机制及转化研究教育部重点实验室北京大学肿瘤医院暨北京市肿瘤防治研究所胃肠肿瘤中心一病区100142

自2019年12月新型冠状病毒肺炎疫情发生后,减少人员流动性的管控措施有助于遏制疫情蔓延,但对于诊断与治疗中的胃癌患者可能会延长预期等待时间。在充分认识胃癌不同分期特点的基础上制订合理的院外管理策略,一方面确立有效的医患沟通渠... 详细信息

自2019年12月新型冠状病毒肺炎疫情发生后,减少人员流动性的管控措施有助于遏制疫情蔓延,但对于诊断与治疗中的胃癌患者可能会延长预期等待时间。在充分认识胃癌不同分期特点的基础上制订合理的院外管理策略,一方面确立有效的医患沟通渠道,患者能够在院外得到合理指导;另一方面与患者共同制订、调整治疗策略并充分告知院外注意事项,可最大程度降低疫情对肿瘤治疗造成的不良影响。

关键词：新型冠状病毒肺炎胃肿瘤等待时间院外管理策略

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