Digestive Diseases and Sciences

, Volume 47, Issue 4, pp 735–740

Unchanging Trend of Adenocarcinoma of the Esophagus and Gastric Cardia in Taiwan: A 15-Year Experience in a Single Center

  • Shen-Shong Chang
  • Ching-Liang Lu
  • Jing-Yi Chao
  • Yee Chao
  • Sang-Hue Yen
  • Sun-Sang Wang
  • Full-Young Chang
  • Shou-Dong Lee


Chronic gastroesophageal reflux disease is closely associated with esophageal adenocarcinoma and gastric cardia carcinoma, and esophageal adenocarcinoma and gastric cardia carcinoma have both been increasing in Western countries recently. Gastroesophageal reflux disease is not rare in Taiwan, but the frequency of occurrence of esophageal adenocarcinoma or gastric cardia carcinoma has not been studied here to date. Patients diagnosed with esophageal and gastric cancers at this hospital between 1981 and 1995 were recruited using the hospital tumor registry database. There were 45, 1546, 970, and 4167 patients diagnosed with esophageal adenocarcinoma, esophageal squamous cell carcinoma, gastric cardia carcinoma, and gastric noncardia adenocarcinoma, respectively. The ratios of esophageal adenocarcinoma versus esophageal squamous cell carcinoma among the three cohorts were 0.030, 0.016, and 0.041, respectively (trend, P = 0.086). The corresponding values for gastric cardia carcinoma versus gastric noncardia adenocarcinoma were 0.252, 0.232, and 0.218, respectively (trend, P = 0.256). The ratios of esophageal adenocarcinoma versus esophageal squamous cell carcinoma and of gastric cardia carcinoma versus gastric noncardia adenocarcinoma have not risen in the three cohorts. Unlike the situation in Western countries, the incidence of esophageal adenocarcinoma and gastric cardia carcinoma versus esophageal squamous cell carcinoma and gastric noncardia adenocarcinoma have not increased over the past 15 years among the Chinese in Taiwan. Although gastroesophageal reflux disease is common here, its definite pathogenesis leading to esophageal adenocarcinoma or gastric cardia carcinoma remains unresolved.

esophageal adenocarocinoma gastric cardia adenocarcinoma gastroesophageal reflux disease 


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  1. 1.
    Devesa SS, Blot WJ, Fraumeni JF Jr: Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer 83:2049–2053, 1998CrossRefPubMedGoogle Scholar
  2. 2.
    Freeny PC: Adenocarcinoma of the esophagus and gastroesophageal junction. Semin Roentgenol 29:373–386, 1994PubMedGoogle Scholar
  3. 3.
    Sharma VK, Chockalingam H, Hornung CA, Vasudeva R, Howden CW: Changing trends in esophageal cancer: A 15-year experience in single center. Am J Gastroenterol 93:702–705, 1998PubMedGoogle Scholar
  4. 4.
    Chen PC, Wu CS, Chang-Chien CS, Liaw YF: Comparison of Olympus GIF-P2 and GIF-K panendoscopy. Taiwan I Hsueh Hui Tsa Chih J Formosan Med Assoc 78:136–140, 1979Google Scholar
  5. 5.
    Department of Health: Directory of Nutrition for People of the Republic of China. Executive Yuan, Republic of China, 1991Google Scholar
  6. 6.
    Yeh C, Hsu CT, Ho AS, Sampliner RE, Fass R: Erosive esophagitis and Barrett's esophagus in Taiwan: A higher frequency than expected. Dig Dis Sci 42:702–706, 1997PubMedGoogle Scholar
  7. 7.
    Lagergren J, Bergstrom R, Lindgren A, Nyren O: Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med 340:825–831, 1999CrossRefPubMedGoogle Scholar
  8. 8.
    Iascone C, DeMeester TR, Little AG, Skinner DB: Barrett's esophagus: Functional assessment, proposed pathogenesis, and surgical therapy. Arch Surg 118:543–549, 1983PubMedGoogle Scholar
  9. 9.
    Altorki NK, Oliveria S, Schrump DS: Epidemiology and molecular biology of Barrett's adenocarcinoma. Semin Surg Oncol 13:270–280, 1997PubMedGoogle Scholar
  10. 10.
    Drewitz DJ, Sampliner RE, Garewal HS: The incidence of adenocarcinoma in Barrett's esophagus: A prospective study of 170 patients followed 4.8 years. Am J Gastroenterol 92:212–215, 1997PubMedGoogle Scholar
  11. 11.
    Stoker DL, Williams JG, Leicester RG, Colin-Jones DG: Oesophagitis: A five year review. Gut 29:A1450, 1988Google Scholar
  12. 12.
    Mold JW, Reed LE, Davis AB, Allen ML, Decktor DL, Robinson M: Prevalence of gastroesophageal reflux in elderly patients in a primary care setting. Am J Gastroenterol 86:965–970, 1991PubMedGoogle Scholar
  13. 13.
    Vaughan TL, Davis S, Kristal A, Thomas DB: Obesity, alcohol, and tobacco as risk factors for cancers of the esophagus and gastric cardia: Adenocarcinoma versus squamous cell carcinoma. Cancer Epidemiol Biomark Prev 4:85–92, 1995Google Scholar
  14. 14.
    Gray JR, Coldman AJ, MacDonald WC: Cigarrette and alcohol use in patients with adenocarcinoma of the gastric cardia or lower esophagus. Cancer 69:2227–2231, 1992PubMedGoogle Scholar
  15. 15.
    Brown LM, Swanson CA, Gridley G, Schoenberg JB, Greenberg RS, Silverman DT, Pottern LM, Hayes RB, Schwartz AG: Adenocarcinoma of the esophagus: Role of obesity and diet. J Natl Cancer 87:104–109, 1995Google Scholar
  16. 16.
    Deurenberg P, Yap M, van Staveren WA. Body mass index and percent body fat: A meta-analysis among different ethnic groups. Int J Obes 22:1164–1171, 1998Google Scholar
  17. 17.
    Parsonnet J, Friedman GD, Vandersteen DP, Chang Y, Vogelman JH, Orentreich N, Sibley PK: Helicobacter pylori infection and the risk of gastric carcinoma. N Engl J Med 325:1127–1131, 1991PubMedGoogle Scholar
  18. 18.
    Hansson LE, Engstrand L, Nyren O, Evans DJ Jr, Lindgren A, Bergstrom R, Andersson B, Athlin L, Bendtsen O, Tracz P: Helicobacter pylori infection: Independent risk indicator of gastric adenocarcinoma. Gastroenterolgy 105:1098–1103, 1993Google Scholar
  19. 19.
    Blaser MJ, Perez-Perez GI, Kleanthous H, Cover TL, Peek RM, Chyou PH, Stemmermann GN, Nomura A: Infection with Helicobacter pylori strains processing cagA is associated with an increased risk of developing adenocarcinoma of the stomach. Cancer Res 55:2111–2115, 1995PubMedGoogle Scholar
  20. 20.
    Parsonnet J, Friedman GD, Orentreich N, Vogelman JH: Risk for gastric cancer in people with cagA positive or cagA negative Helicobacter pylori infection. Gut 40:297–301, 1997PubMedGoogle Scholar
  21. 21.
    Chow WH, Blaser MJ, Blot WJ, Gammon MD, Vaughan TL, Risch HA, Perez-Perez GI, Schoenberg JB, Stanford JL, Rotterdam H, West AB, Fraumeni JF Jr: An inverse relation between cagA strains of Helicobacter pylori infection and risk of esophageal and gastric cardia adenocarcinoma. Cancer Res 58:588–590, 1998PubMedGoogle Scholar
  22. 22.
    Teh BH, Lin JT, Pan WH, Lin SH, Wang LY, Lee TK, Chen CJ: Seroprevalence and associated risk factors of Helicobacter pylori infection in Taiwan. Anticancer Res 14:1389–1392, 1994PubMedGoogle Scholar
  23. 23.
    Yang JC, Wang TH, Wang HJ, Kuo CH, Wang JT, Wang WC: Genetic analysis of the cytotoxin-associated gene and the vacuolating toxin gene in Helicobacter pylori strains isolated from Taiwanese patients. Am J Gastroenterol 92:1316–1321, 1997PubMedGoogle Scholar
  24. 24.
    Dooley CP, Cohen H, Fitzgibbons PL, Bauer M, Appleman MD, Perez-Perez GI, Blaser MJ: Prevalence of Helicobacter pylori infection and histologic gastritis in asymptomatic persons. N Engl J Med 321:1562–1566, 1989PubMedGoogle Scholar
  25. 25.
    Taylor D, Blaser MJ: The epidemiology of Helicobacter pylori infection. Epidemiol Rev 13:42–59, 1991PubMedGoogle Scholar
  26. 26.
    Crabtree JE, Taylor JD, Wyatt JI, Heatley RV, Shallcross TM, Tompkins DS, Rathbone BJ: Mucosal IgA recognition of Helicobacter pylori 120 kDa protein, peptic ulceration, and gastric pathology. Lancet 338:332–335, 1991PubMedGoogle Scholar
  27. 27.
    Cover TL, Glupczynski Y, Lage AP, Burette A, Tummuru MKR, Perez-Perez GI, Blaser MJ: Serologic detection of infection with cagA+ Helicobacter pylori strains. J Clin Microbiol 33:1496–1500, 1995PubMedGoogle Scholar
  28. 28.
    Atherton JC, Cao P, Peek, Jr RM, Tummurn MKR, Blaser MJ, Cover TL: Mosaicism in vacuolating cytotoxin alleles of Helicobacter pylori. J Biol Chem 270:17771–17777, 1995PubMedGoogle Scholar
  29. 29.
    Clark GW, Smyrk TC, Burdiles P, Hoeft SF, Peters JH: Is Barrett's metaplasia the source of adenocarcinoma of the cardia? Arch Surg 129:609–614, 1994PubMedGoogle Scholar
  30. 30.
    Sampliner RE: Adenocarcinoma of the esophagus and gastric cardia: Is there progress in the face of increasing cancer incidence? Ann Intern Med 130:67–69, 1999PubMedGoogle Scholar
  31. 31.
    Spechler SJ, Robbins AH, Rubins HB, Vincent ME, Heeren T, Doos WG, Colton T, Schimmel EM: Adenocarcinoma and Barrett's esophagus. An overrated risk? Gastroenterology 87:927–933, 1984PubMedGoogle Scholar
  32. 32.
    Sontag SJ, Schnell TG, Chejfec G, O'Connell S, Stanley MM, Best W, Chintam R, Nemchausky B, Wanner J, Moroni B: Barrett's oesophagus and colonic tumours. Lancet 1:946–949, 1985PubMedGoogle Scholar

Copyright information

© Plenum Publishing Corporation 2002

Authors and Affiliations

  • Shen-Shong Chang
    • 1
  • Ching-Liang Lu
    • 1
  • Jing-Yi Chao
    • 1
  • Yee Chao
    • 1
  • Sang-Hue Yen
    • 1
  • Sun-Sang Wang
    • 1
  • Full-Young Chang
    • 1
  • Shou-Dong Lee
    • 1
  1. 1.Division of Gastroenterology, Division of General Medicine, Department of Medicine, Cancer Center, Taipei Veterans General Hospital andNational Yang-Ming University School of MedicineTaipeiTaiwan

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