The Changing Face of Noncardia Gastric Cancer Incidence Among US Non-Hispanic Whites
The Changing Face of Noncardia Gastric Cancer Incidence Among US Non-Hispanic Whites
复制标题
DOI：
10.1093/jnci/djx262
复制
发表时间：
2018-06-01
影响因子：
10.3
通讯作者：
Camargo, M. Constanza
中科院分区：
文献类型：
--
作者：
Anderson, William F.;Rabkin, Charles S.;Camargo, M. Constanza
背景资料：非贲门胃癌发生的第一步是萎缩性胃炎，由幽门螺杆菌感染或自身免疫引起。近几十年来，随着西方生活方式的改变，这两个主要原因的流行率分别下降和上升。因此，我们评估了1995- 2013年美国人种/种族组的胃癌发病率趋势。方法：通过估计的年百分比变化（EAPC）和95%置信区间（CI）总结了45个北美中央癌症协会肿瘤登记处的标准化率（ASR）。年龄段队列模型补充了标准的描述性技术和预测未来的trends.Results：有137947非贲门癌在4.4亿人年的观察。在非西班牙裔白人中，ASR为2.2/10万人-年，EAPC为-2.3%（95% CI = -2.0%至-2.6%）。尽管总体下降，但年龄小于50岁的人的EAPC上升了1.3%（95% CI = 0.6%至2.1%），老年人下降了-2.6%（95% CI = -2.4%至2.9%）。这些趋同趋势表明，女性的出生队列效应比男性更明显，1983年出生的女性的发病率是1951年出生的女性的两倍（95% CI = 1.1倍至3.6倍）。年龄的相互作用在西班牙裔白人中也有统计学意义，年轻人和老年人的EAPC分别略有增加和减少。其他种族的发病率下降与年龄无关。目前的趋势预示着预期的逆转在发病率下降和男性占主导地位的non-Hispanic white.Conclusions：与现代生活条件相关的胃微生物组的生态失调可能会增加自身免疫性胃炎和随之而来的非贲门癌的风险。胃癌的年龄和性别的变化值得分析研究，以确定潜在的因果机制。
Background: The initial step for noncardia gastric carcinogenesis is atrophic gastritis, driven by either Helicobacter pylori infection or autoimmunity. In recent decades, the prevalence rates of these two major causes declined and increased, respectively, with changes in Western lifestyles. We therefore assessed gastric cancer incidence trends for US race/ethnic groups, 1995-2013.Methods: Age-standardized rates (ASRs) from 45 North American Association of Central Cancer Tumor Registries were summarized by estimated annual percentage change (EAPC) and 95% confidence intervals (CIs). Age period cohort models supplemented standard descriptive techniques and projected future trends.Results: There were 137947 noncardia cancers in 4.4 billion person-years of observation. Among non-Hispanic whites, the ASR was 2.2 per 100 000 person-years, with an EAPC of -2.3% (95% CI = -2.0% to -2.6%). Notwithstanding this overall decline, EAPCs rose 1.3% (95% CI = 0.6% to 2.1%) for persons younger than age 50 years and fell -2.6% (95% CI = -2.4% to -2.9%) for older individuals. These converging trends manifested a birth cohort effect more pronounced among women than men, with incidence among women born in 1983 twofold (95% CI = 1.1-fold to 3.6-fold) greater than those born in 1951. Age interaction was also statistically significant among Hispanic whites, with slightly increasing vs decreasing EAPCs for younger and older individuals, respectively. Incidence declined regardless of age for other races. Current trends foreshadow expected reversals in both falling incidence and male predominance among non-Hispanic whites.Conclusions: Dysbiosis of the gastric microbiome associated with modem living conditions may be increasing risk of autoimmune gastritis and consequent noncardia cancer. The changing face by age and sex of gastric cancer warrants analytical studies to identify potential causal mechanisms.