A global perspective on oesophageal cancer: two diseases in one
Menée dans 195 pays et territoires sur la période 1990-2017, cette étude analyse l’évolution des facteurs associés au risque de cancer de l’œsophage et la mortalité spécifique
Résumé en anglais
Oesophageal cancer represents the sixth most common cause of cancer mortality worldwide. Underlying this cancer type are two distinct diseases characterised by different histologies: oesophageal adenocarcinoma and oesophageal squamous cell carcinoma. Oesophageal adenocarcinoma predominately arises from Barrett's oesophagus, with histological progression from metaplasia through to invasive carcinoma, and is typically localised to the distal oesophagus. The main risk factors are gastro-oesophageal reflux and obesity; high intake of red meat and low intake of fruits and vegetables are also associated with development of oesophageal adenocarcinoma. Oesophageal squamous cell carcinoma develops from squamous epithelial cells and is typically localised to the upper two-thirds of the oesophagus. Tobacco consumption and alcohol intake are the most notable risk factors, although their relative risk varies by region. The GBD 2017 Oesophageal Cancer Collaborators used data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 dataset to provide a global overview of the distribution of oesophageal cancer and the morbidity, mortality, and key risk factors associated with the disease.They describe national trends in incidence between 1990 and 2017 as well as the impact of risk factors on a regional level. Between 1990 and 2017, age-standardised incidence rates declined overall by 22·0% (95% uncertainty interval 18·6–25·2). This decline in age-standardised incidence was observed in all regions except for high-income North America (where oesophageal adenocarcinoma is predominant) and western sub-Saharan Africa. At the country level, there was an association between a higher proportion of squamous cell carcinoma (out of all oesophageal cancer cases) and lower socioeconomic development. The global variation to a large extent recapitulates that seen from an analysis of data from the Global Cancer Observatory (GLOBOCAN) and Cancer Incidence in Five Continents, Volume X (CI5X). A major limitation of this analysis of GBD 2017 data, acknowledged by the authors, is the inability to clearly demarcate between oesophageal adenocarcinoma and oesophageal squamous cell carcinoma. Summary data on oesophageal cancer as a whole should not mask the differing global distribution, risk factors, and temporal changes occurring between the two diseases. Their distinct biology is reflected in their management approaches. (…)
