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UDC 616.33-006.04-036.22(571.15)
EPIDEMIOLOGICAL ASPECTS OF GASTRIC AND CARDIAC CANCER MORBIDITY IN ALTAI KRAI
Altai State Medical University, Barnaul
Altai branch of N.N. Blokhin Russian Cancer Research Center , Barnaul Altai Regional Oncological Center, Barnaul
V.P. Nechyunayev, A.G. Ageyev, A.U. Panasyan, M.Ye. Sakhran, A.F. Lazarev
The epidemiology of stomach cancer and cardia is an urgent problem of modern healthcare and it ranks second (13.5%) in the structure of mortality from cancer in Russia. Stomach cancer ranks fourth (7.9%) among men, and fifth (5.2%) among women. The article presents the epidemiological analysis of the morbidity of stomach cancer in Altai Krai; it provides recommendations for reducing risks and morbidity rates. Key words: oncological diseases, stomach cancer, epidemiology of non-infectious diseases.
Despite the reduction of morbidity, gastric cancer (GC) remains one of the most common diseases in the world. Yearly, there are registered more than 1 million cases. In the overwhelming majority of countries, GC morbidity in men is 2 times higher than in women. The morbidity level varies rather widely [8;9]. Thus, according to the latest IARC edition "Cancer on 5 continents" (Volume 7), it is absolutely evident, that the value of GC morbidity rate is influenced by the character and regime of nutrition. The presence of enough plant food and fruits, animal and vegetable proteins in the food ration considerably decreases the risk of GC. The most demonstrative example is the USA, where during the last 70 years of sensible nutrition promotion the GC morbidity of population has significantly reduced. It should be noted, that a considerable decrease of GC was registered also in migrants from Japan permanently residing in the USA, especially in the second and third generations.
Research objective: to reveal the epidemiolog-ical aspects of gastric cancer and cardia morbidity in the territory of Altai Krai.
Materials and methods
The materials for the retrospective epidemio-logical analysis of gastric cancer and cardia morbidity in the territory of Altai Krai and the Russia Federation included the statistical data of official sources, there was performed the statistical processing of the obtained data.
Russia refers to the countries with high GC morbidity level with more than 37 thousand new cases registered annually [12]. However, there has emerged a trend to the reduction of GC morbidity in Russia. Since 1990 the morbidity has decreased by 21 thousand (35%) and constituted 37,8 thousand (2015) (Figure 1, 2).
In the structure of oncological morbidity among men GC ranks 4th (7,9%), among women - 5th (5,2%), in the structure of mortality - 2nd (13,5%) [1]. In this regard, the problem of GC epidemiology, its early
diagnostics and prevention remain topical.
According to the level of GC mortality in the array of 45 countries Russia holds the 2nd position (in men) and 3rd position (in women). Despite the reduction of morbidity, during the recent 10 years the rate of mortality in the first year even increased, which is connected with the growth of the number of patients with IV stage. In 2015 in Altai Krai the standardized index of GC mortality in men constituted 19,4, in women - 7,5 per 100 000 population, which is somewhat higher than the Russian index (17.9 and 7,3 respectively) [1; 2]. The highest survival rate is registered in Japan - 53%, in other countries it does not exceed 15-20% [5]. The rate of early GC in Japan is also the highest and constitutes the half of all cases, while in Europe, the USA and other countries - not -exceeding 20%. The success of survival improvement in Japan is determined by screening of population and establishment of national cancer programs [14].
During the past decade there has been registered an increase of morbidity of cardio-esophageal cancer and a decrease of antral cancer morbidity, and this trend is most well-marked in European countries, while Japan is dominated by athral cancer [4; 13]. It is supposed, that GC of distal organs is associated with the Helicobacter pylori infection (HP), and eradicational treatment regimens cause HP migration in the proximal direction leading to the can-cerogenic effect in the cardio-esophageal zone.
Researchers pay great attention to the role of HP by the determination of GC causes. After in 1983 B.J. Marchall [15], while studying the biopsy materials of gastric mucosa of patients with ulcer disease, discovered and described a microorganism classified as HP subsequently considered as the leading one in the etiology of chronic nonimmune antral gastritis, the researchers became interested in its influence on GC.
Ye.L. Fisheleva [11] notes in the survey for the role of HP in GC development, that according to the studies conducted in the USA and England, the risk of GC development in the infected
Figurel.
Dynamics of GC morbidity of the Russian population (men)
Figure 2.
Dynamics of GC morbidity of the Russian population (women)
patients is 3,8 times higher than in the nonifected patients. Prospective researcher performed with an interval of 15 years and more revealed HP infection in 90%, and by ruling out cardiac cancer this percent became even higher. According to our observations, HP bacterization by GC constituted 92%.
In Altai Krai there was also marked the reduction of GC morbidity during recent 20 years, both in men (from 41,9 to 37,7) and in women (from 16,8 to 10,5) per 100 thousand population (Figure 3,4).
Figure 3.
GC morbidity in the Western-Siberian region ("Crude" index. 2015)
Figure 4.
GC morbidity in the Western-Siberian region (Standardized index. 2015)
In the Western-Siberian region6 there is observed the territorial inequality of GC extension (Figure 3,4). There is revealed the connection of the disease with the regional specifics, which is determined by the peculiarities of the live environment including natural landscape, anthro-
po-ecological characteristics, presence of rhodonic waters, seismic activity, health levels, population density and migration manifesting itself firstly through the factors of nutrition and stress. Critically important is also the factor of social and natural strain caused by the stress syndrome of population
[9]. GC morbidity in Altai Krai among Western-Siberian regions is higher both in men and women, and is conditioned by such natural factors as natural rhodon, technogenic pollution by salts of heavy metals, consequences of explosions at Semipala-tinsk test site.
Over the past 20 years in the whole world there has been marked a sharp increase of cardio-esoph-ageal cancer (CEC) against the background of GC morbidity reduction, which makes the problem of treatment of neoplasms of the stated location extremely topical. The rates of growth of this neo-
plasm morbidity exceeded identical rates by other malignant tumors [3; 12] (Figure 5).
The experience of numerous large clinics show, that CEC and cancer of other gastric elements are different diseases. Tumors of the cardio-esophageal zone metastized not only into abdominal, but often into mediastinal lymph nodes. From the point of prognosis they are more unfavorable than gastric or esophageal cancer. In Altai Krai CEC morbidity over the recent 20 years has grown nearly by 2 times (1994 - 2,1 2015- 3,9) (Figure 5).
5,4
4.8 4,8 4-9
4.1 /-B-* \ 4,3 4,3 / 4,8 3,8 A 3-9
/ 3 9 3,0/ 3,9 4.0
2.4 yf 3,3 32 3.4
* **""2.5
Z3
--1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1
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Figure 5.
Dynamics of CEC morbidity in Altai Krai (both genders). "Crude" index
Figure 6.
Age characteristics of CEC morbidity in Altai Krai during the past 10 years
The basic contingent of CEC morbidity is accounted for the age group of 50-60 years (76,3%) (Figure 6).
At the joint conference of the International gastric cancer association and the International society for diseases of the esophagus in 2000 the expert committee recommended the classification suggested by J.R.Siewert (1987). It is simple for understanding and practical use. The classification is based on the anatomic center of the tumor with Z-line as the starting point. The classification allows to differentiate the tumors located in the area of esophagogastric junction and to choose the most suitable surgical access.
Treatment of CEC still remains a multifaceted topical problem. Increased attention of the surgeons is focused on the problem of adequate access, degree of surgical intervention, volume of lymph node dissection, reduction of postoperative mortality and improvement of functional consequences of operations on cardio-esophageal cancer. Numerous researches both in the RF and abroad are devoted to the search of adequate methods of surgical treatment and elaboration of effective combined methods.
During the past 20 years in Altai Krai there has been registered 596 cases of CEC morbidity. Men are exposed to this disease nearly 2 times oftener than women (31,4% and 69,6%). CEC morbidity is higher among urban population (54,7%) in comparison with rural population (45,3%).
Table 1
Tumor localization according to gastric elements (2005-2015)
Gastric element ICD-10 %
Cardia C16.0 11,6
Gastric fundus C16.1 0,8
Gastric corpus C16.2 35,7
Pyloric end of stomach C16.3 2,2
Pylorus C16.4 18,4
Lesser curvature C16.5 4,3
Major curvature C16.6 1,6
Extensive overall gastric affection C16.8 4,7
Nonrefinement gastric localization C16.9 20,7
TOTAL (5498 cases) C16 100
According to our observations, out of 5498 cases of GC the tumor localization during recent years gradually moves to the upper gastrointestinal due to the conducted treatment described above. Thus, cardio-esophageal cancer constitutes 11,6% (Table 1).
According to J.R. Siewert tumor classification, in our studies tumors were located: I type - in men - 31,4%, in women - 16,8%, II type - 65,9% in men, 79,4% in women, III type - 2,6% in men and 3,8% in women. The frequency of CEC of I type occurrence is determined by Barrett's epithelia metaplasia connected with the character of nutrition (smoking, alcohol abuse).
Table 2
Histological structure of cardio-esophageal tumors (2000-2015)
Code ICD-0-2 Name Number of cases %
8140/3 Adenocarcinoma NOS 76 12,8
8140/3 High-grade differentiated adc 126 21,2
8140/3 Moderately differentiated adc 178 29,8
8140/3 Low-grade differentiated adc 165 27,7
8071/3 Squamous cell keratinous carcinoma 14 2,3
8072/3 Squamous cell nonkeratinous carcinoma 9 1,5
8231/3 Carcinoma simplex 4 0,7
8480/3 Mucinous adenocarcinoma 9 1,5
8560/3 Adenosquamous carcinoma 6 1,0
8260/3 Papillary adenocarcinoma 5 0,8
8240/3 Argentaffin carcinoma 4 0,7
TOTAL morphologically verified 596 100%
There were primarily observed different types of adenocarcinoma constituting 92% of tumors. Irrespective of the tumor type there dominate low-grade differentiated varieties. Squamous cell carcinoma constituted 3,8% (Table 2).
Conclusion
Thus, GC and cardiac cancer remains an extremely pressing problem in Russia. In the mortality structure it holds the second position (13,5%). "Early cancer" is diagnosed in 10% of cases, 75% of primary diagnosed gastric cancer are registered at III-
IV stages, 83% of patients by the moment of case definition have metastases into regional lymph nodes. Thus, there are required screening programs for definition of the most common gastric cancer forms, and in modern conditions HC screening should be conducted at least in the groups of background and pre-malignant diseases. In this respect there is needed the popularization of knowledge (including TV, radio, leaflets etc.) about GC among general practitioners and among the population. A special role should be given to therapists, gastro-enterologists, endoscopists. An effective measure of GC prevention can be the change of nutrition. Patients with GC should be treated in specialized medical institutions. By family GC there should be carried medical genetic consultation of relatives.
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Contacts:
Corresponding author - Lazarev Aleksandr Fedor-ovich, Doctor of Medical Sciences, Professor, Head of the Department of oncology, radiation therapy and diagnostics with the course of further vocational education of the FSBEI HE Altai State Medical University of the Ministry of Health of the Russian Federation, Barnaul. 656038, Barnaul, Lenina Prospekt, 40. Tel.: (3852) 366858. Email: aoc@ab.ru
