Cardia

Data in a regional cancer registry covering a population of 5 million and with an efficiency of registration of over 95% have been used to examine incidence trends in oesophageal and gastric carcinoma. In the West Midlands Region of the UK, during the period 1962 to 1981 the age standardised incidence of gastric carcinoma decreased by 20%. However, an analysis by both histological type and detailed site reveals that while the incidence of distal lesions is diminishing, the incidence of adenocarcinoma of the oesophagus and cardia is increasing. The proximal and distal lesions also exhibit marked differences in social class distribution and sex ratio. The results strongly suggest that the aetiological factors involved for cardia and adjoining sites are different from those for pyloric antrum.

BackgroundHelicobacter pylori infection is a major cause of non-cardia gastric cancer (NCGC), but its causal role in cardia gastric cancer (CGC) is unclear. Moreover, the reported magnitude of association with NCGC varies considerably, leading to uncertainty about population-based H pylori screening and eradication strategies in high-risk settings, particularly in China, where approximately half of all global gastric cancer cases occur. Our aim was to assess the associations of H pylori infection, both overall and for individual infection biomarkers, with the risks of NCGC and CGC in Chinese adults.MethodsA case-cohort study was done in adults from the prospective China Kadoorie Biobank study, aged 30-79 years from ten areas in China (Qingdao, Haikou, Harbin, Suzhou, Liuzhou, Henan, Sichuan, Hunan, Gansu, and Zhejiang), and included 500 incident NCGC cases, 437 incident CGC cases, and 500 subcohort participants who were cancer-free and alive within the first two years since enrolment in 2004-08. H pylori biomarkers were measured in stored baseline plasma samples using a sensitive immunoblot assay (HelicoBlot 2.1), with adapted criteria to define H pylori seropositivity. Cox regression was used to estimate adjusted hazard ratios (HRs) for NCGC and CGC associated with H pylori infection. These values were used to estimate the number of gastric cancer cases attributable to H pylori infection in China.FindingsOf the 512 715 adults enrolled in the China Kadoorie Biobank between June, 2004, and July, 2008, 500 incident NCGC cases, 437 incident CGC cases, and 500 subcohort participants were selected for analysis. The seroprevalence of H pylori was 94·4% (95% CI 92·4-96·4) in NGCG, 92·2% (89·7-94·7) in CGC, and 75·6% (71·8-79·4) in subcohort participants. H pylori infection was associated with adjusted HRs of 5·94 (95% CI 3·25-10·86) for NCGC and 3·06 (1·54-6·10) for CGC. Among the seven individual infection biomarkers, cytotoxin-associated antigen had the highest HRs for both NCGC (HR 4·41, 95% CI 2·60-7·50) and CGC (2·94, 1·53-5·68). In this population, 78·5% of NCGC and 62·1% of CGC cases could be attributable to H pylori infection. H pylori infection accounted for an estimated 339 955 cases of gastric cancer in China in 2018.InterpretationAmong Chinese adults, H pylori infection is common and is the cause of large numbers of gastric cancer cases. Population-based mass screening and the eradication of H pylori should be considered to reduce the burden of gastric cancer in high-risk settings.FundingCancer Research UK, Wellcome Trust, UK Medical Research Council, British Heart Foundation, Kadoorie Charitable Foundation, National Key Research and Development Program of China, and National Natural Science Foundation of China.

BackgroundRecent evidence suggests that CD4+CD25+FoxP3+ regulatory T-cells (Treg) may be responsible for the failure of host anti-tumour immunity by suppressing cytotoxic T- cells. We assessed the prognostic significance of tumour infiltrating lymphocytes (TIL) in intestinal-type gastric cardiac cancer.MethodsTumour infiltrating lymphocyte (TIL) subsets and tumour infiltrating macrophages (TIM) were investigated in 52 cases using tissue microarrays. The interrelationship between the cell populations (CD3+, CD8+, CD20+, CD68+, GranzymeB+, FoxP3+) in different compartments and NED-survival was investigated (median follow-up time: 61 months).ResultsIntraepithelial infiltration with TIL and TIM including Treg was generally low and not related to NED-survival. However, patients with large numbers of FoxP3+ Treg in the tumour stroma (>125.9 FoxP3+TILs/mm2) had a median survival time of 58 months while those with low FoxP3+ TIL counts (ConclusionOur results suggest that inflammatory processes within the tumour stroma of gastric intestinal-type adenocarcinomas located at the gastric cardia may affect outcome in two ways. Tumour-infiltrating macrophages are likely to promote carcinogenesis while large numbers of Treg are associated with improved outcome probably by inhibiting local inflammatory processes promoting carcinogenesis. Thus, inhibition of Treg may not be a feasible treatment option in gastric adenocarcinoma.

BackgroundCardia gastric cancer (CGC) is a distinct and increasingly prevalent malignancy, yet the role of air pollution in its sequential carcinogenesis remains unclear. The present cross-sectional study aimed to evaluate the associations between long-term exposure to ambient air pollution and the progression of precancerous cardia gastric lesions.MethodsA total of 99,493 participants were enrolled from the National Opportunistic Screening Program for Upper Gastrointestinal Cancer in Zhejiang Province of China from 2022 to 2023. Long-term exposure to six air pollutants including particulate matter (PM10), fine particulate matter (PM2.5), sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), and carbon monoxide (CO) was assessed by using ChinaHighAirPollutants (CHAP) dataset. Cardia lesion progression was classified into five histopathological stages based on endoscopic biopsy. Ordinal logistic regression was used to examine pollutant-specific associations, restricted cubic splines (RCS) were applied to assess the potential exposure-response associations, and weighted quantile sum (WQS) regression was performed to evaluate the mixture effects.ResultsAll six pollutants were significantly associated with cardia lesion progression. The adjusted odds ratios (95% confidence intervals, 95% CI) per standard deviation increment in 5-year mean concentration were 1.21 (1.17-1.25) for PM10, 1.28 (1.23-1.32) for PM2.5, 1.17 (1.13-1.21) for SO2, 1.07 (1.03-1.10) for NO2, 1.16 (1.12-1.20) for O3, and 1.36 (1.30-1.41) for CO. RCS analyses indicated non-linear exposure-response patterns for NO2, O3, and CO. In mixture models, CO and PM2.5 were identified as the predominant contributors, with a 10% increase in combined exposure associated with a 10% (95% CI: 7-13%) higher risk of cardia lesion progression. Effect modification analysis revealed that Helicobacter pylori-positive individuals were more susceptible to pollution-related progression.ConclusionsLong-term exposure to air pollutants is associated with the progression of cardia gastric lesions, highlighting the importance of incorporating air quality improvement into cancer prevention strategies.