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DOI: 10.1055/s-2002-32375
Aktuelle Epidemiologie des Ösophaguskarzinoms und des Kardiakarzinoms in Deutschland
Current epidemiology of carcinoma of the esophagus and cardia in GermanyPublikationsverlauf
4.4.2002
22.5.2002
Publikationsdatum:
20. Juni 2002 (online)

Hintergrund und Fragestellung: In den westlichen Ländern stieg in den letzten 20 - 30 Jahren die Inzidenz des Adenokarzinoms (AC) des Ösophagus sowie der Kardia, die des Plattenepithelkarzinoms (PC) des Ösophagus blieb dagegen meist konstant. Welche aktuellen Daten zur Epidemiologie dieser Karzinome in deutschen Bundesländern liegen vor?
Methodik: Die Daten des Epidemiologischen Krebsregisters Saarland und des Gemeinsamen Krebsregisters der neuen Bundesländer und Berlin wurden untersucht. Aufgrund der exzellenten Melderaten wurden Saarland, Mecklenburg-Vorpommern, Brandenburg und Sachsen ausgewählt. Daraus wurden auf die Weltbevölkerung altersstandardisierte Inzidenzen berechnet.
Ergebnisse: Für die männliche Bevölkerung des Saarlandes stieg die Inzidenz des Ösophagus-AC von 0,22 im Jahre 1986 auf 1,17 1997 (Zunahme um 432 %), in Brandenburg, Mecklenburg-Vorpommern und Sachsen von 0,23 1977 auf 0,8 1998 (248 %). Das Ösophagus-PC trat in beiden Krebsregistern seit 1986 mit weitgehend konstanter Häufigkeit auf; die Inzidenz betrug 1998 3,31 in den drei neuen Bundesländern und 5,05 im Saarland. Bei Frauen lag die Inzidenz wesentlich niedriger. Unter 10 % der Ösophaguskarzinome wurden 1996 - 1998 im Stadium UICC I (T1N 0 M0, Frühkarzinome) diagnostiziert. Entsprechend lag das 5-Jahres-Überleben aller 1374 Ösophaguskarzinom-Patienten im Krebsregister Saarland 1971 - 1995 unter 10 %. Das AC der Kardia des Magens zeigt ebenfalls eine Zunahme. In den drei neuen Bundesländern stieg bei Männern die Inzidenz von 1,27 im Jahre 1977 auf 2,18 1998, bei Frauen von 0,4 auf 0,58. Im gleichen Zeitraum nahmen die Malignome des gesamten Magens einschließlich Kardia bei Männern von 29,5 auf 17,1 und bei Frauen von 14,3 auf 9,2 ab.
Folgerung: In Deutschland hat in den letzten 15-20 Jahren das AC des Ösophagus und vermutlich auch der Kardia an Häufigkeit zugenommen. Die Inzidenz des Plattenepithelkarzinoms des Ösophagus blieb in den letzten 10 Jahren hingegen weitgehend konstant. Der Anteil der Frühkarzinome und das 5-Jahres-Überleben liegen beim Ösophaguskarzinom nach wie vor unter 10 %.
Background and objective: In the past 20-30 years the incidence of adenocarcinoma (AC) of the esophagus and the cardia has risen in western countries, while that of squamous cell carcinoma (SC) of the esophagus has largely stayed constant. Current data in the epidemiology of these cancers in Germany were analysed.
Methods and material: The data of the epidemiological cancer register of the Saarland (Old State of former West Germany) and the combined registers of the New States of Germany (former East Germany) and Berlin were collected. Because of the excellent registration procedures, data from the Saarland and the New States, Mecklenburg-Pommern, Brandenburg and Saxony were selected for this study. The incidence was calculated and corrected for age in relation to the world population.
Results: The incidence of esophageal AC among males in the Saarland rose from 0.22 per 100 000 population to 1.17 between 1986 to 1997, an increase of 432%, while in Brandenburg, Mecklenburg-Vorpommern and Saxomy it rose, between 1977 and 1998, from 0.23 to 0.8 i.e. by 248%. Esophageal SC incidence remained largely constant in both cancer registers since 1986. In 1998 it was 3.31 in the three New States of Germany and 5.05 in the Saarland. In females the incidence was markedly lower. In 1996-1998 fewer than 10% of cases of esophageal cancer were in UICC stage 1 (T1N0M0, early carcinoma). Correspondingly the 5-year survival of all patients with esophageal carcinoma in the Saarland was less than 10% in 1971-1995. AC of the cardia also increased. In the three New States of Germany the incidence among males rose from 1.27 in 1977 to 2.18 in 1998, in females from 0.4 to 0.58. During the same period malignant tumors of the entire stomach, including the cardia, decreased in males from 29.5 to 17.1, in females from 14.3 to 9.2.
Conclusion: In Germany, during the past 15-20 years, the incidence of esophageal AC and presumably also of AC of the cardia has increased. But the incidence of squamous cell carcinoma of the esophagus has remained largely constant. The proportion of early carcinoma and the 5-year survival with esophageal carcinoma remains under 10%.
Literatur
- 1
Devesa S S, Blot W J, Fraumeni J F.
Changing patterns in the incidence
of esophageal and gastric carcinoma in the United States.
Cancer.
1998;
10
2049-2053
MissingFormLabel
- 2
Spechler S.
Barrett’s
esophagus.
N Engl J Med.
2002;
346
836-842
MissingFormLabel
- 3
Hansen S, Johan N.
Esophageal and gastric cancer
in Norway 1958 - 1992.
Int
J Cancer.
1997;
71
340-344
MissingFormLabel
- 4
Moller H.
Incidence
of cancer of the oesophagus, cardia and stomach in Denmark.
Eur
J Cancer Prev.
1992;
1
159-164
MissingFormLabel
- 5
Hansson L E, Sparen P, Nyren O.
Increasing
incidence of both major histological types of esophageal carcinomas
among men in Sweden.
Int J Cancer.
1993;
54
402-407
MissingFormLabel
- 6
Powell J, Mc Conkey C C.
The rising trend
in oesophageal adenocarcinoma and gastric cardia.
Eur
J Cancer Prev.
1992;
1
265-269
MissingFormLabel
- 7
Mc Kinney P A, Sharp L, MacFarlane G J. et al .
Oesophageal and gastric cancer in Scotland
1960 - 90.
Brit J Cancer.
1995;
71
411-415
MissingFormLabel
- 8
Levi F, Randimbison L, La V ecchia
C.
Epidemiology of adenocarcinoma and squamous
cell carcinoma of the esophagus.
Eur J Cancer Prev.
2001;
10
91-96
MissingFormLabel
- 9
Liabeuf A, Faivre J.
Time trends in oesophageal
cancer incidence in Cote d‘Or (France) 1976 - 93.
Eur
J Cancer Prev.
1997;
6
24-30
MissingFormLabel
- 10
Sihvo E IT, Salminen J T, Rämö O J.
The epidemiology of oesophageal
AC.
Scand J Gastroenterol.
2000;
10
1082-1086
MissingFormLabel
- 11
Siewert J R, Stein H J.
Classification
of adenocarcinoma of the esophagogastric junction.
Brit
J Surgery.
1998;
85
1457-1459
MissingFormLabel
- 12
Lagergren J, Bergström R. et al .
Symptomatic
gastroesophageal reflux as a risk factor for esophageal adenocarcinoma.
N
Engl J Med.
1999;
340
825-831
MissingFormLabel
- 13
Bollschweiler E, Hölscher A H.
Deutliche
Zunahme des Adenokarzinoms im Ösophagus.
Dt Ärztebl.
2000;
97
A1896-1900
MissingFormLabel
- 14
Launoy G, Grosclaude P, Pienkowski P. et al .
Les cancers digestif en France. Comparision
de l`incidence dans 7 departements et estimation de l‘incidence
pour la France entiere.
Gastroenterol Clin Biol.
1992;
16
633-638
MissingFormLabel
- 15
Lagergren J, Bergstrom R, Lindgren A, Nyren O.
The role of tobacco, snuff and
alcohol use in the aetiology of cancer of the oesophagus and gastric
cardia.
Int J Cancer.
2000;
85
340-346
MissingFormLabel
- 16
Scherübl H, von Lampe B, Faiss S, Däubler P, Bohlmann P, Plath T, Foss H D, Scherer H, Strunz A, Hoffmeister B, Stein H, Zeitz M, Riecken E -O.
Screening for
oesophageal neoplasia in patients with head and neck cancer.
Brit
J Cancer.
2002;
86
239-243
MissingFormLabel
- 17
Scherübl H, Scherer H, Hoffmeister B.
Second
esophageal cancers in head and neck cancer patients.
N
Engl J Med.
2002;
346
1416-1417
MissingFormLabel
- 18
Ekstrom A M, Signorello L B, Hansson L E. et al .
Evaluating gastric
cancer misclassification.
J Natl Cancer Inst.
1999;
91
786-790 and 1586
MissingFormLabel
- 19
Spechler S. et al .
Long-term outcome of medical and surgical
therapies for gastroesophageal reflux disease.
JAMA.
2001;
285
2331-2338
MissingFormLabel
- 20
Hansen S, Melby K K, Aase S. et al .
H. pylori infection and risk of cardia
and non-cardia gastric cancer.
Scand J Gastroent.
1999;
4
353-360
MissingFormLabel
- 21
El-Serag H B, Sonnenberg A.
Opposing time trends
of peptic ulcer and reflux disease.
Gut.
1998;
43
327-333
MissingFormLabel
- 22
Chow W -H, Blaser M J, Blot W J. et al .
An inverse relation between
cagA+ strains of H. pylori infection and risk of esophageal
and gastric cardia adenocarcinoma.
Cancer Res.
1998;
58
588-590
MissingFormLabel
- 23
Weston A P, Badr A S, Topalowski M. et al .
Prospective evaluation of the prevalence
of gastric H. pylori infection in patients with GERD, Barrett’s
esophagus, Barrett’s dysplasia, and Barrett’s
AC.
Am J Gastroentrol.
2000;
95
387-394
MissingFormLabel
- 24
Freedman J, Lagergren J, Bergstrom R, Naslund E, Nyren O.
Cholecystectomy,
peptic ulcer disease and the risk of adenocarcinoma of the oesophagus and
gastric cardia.
Br J Surg.
2000;
87
1087-1093
MissingFormLabel
- 25
Sipponen P, Hyvärinen H.
Role of H.
pylori in the pathogenesis of gastritis, peptic ulcer and gastric
cancer.
Scand J Gastroenterol.
1993;
28
(Suppl 196)
3-6
MissingFormLabel
- 26
El Omar E M, Penman I D, Ardill J E. et al .
H. pylori infection, and
abnormalities of acid secretion in patients with duodenal ulcer
disease.
Gastroenterology.
1995;
109
681-691
Aliment Pharmacol Ther.
2001;
15
813-820
MissingFormLabel
- 27
Labenz J, Blum A L. et al .
Curing
H pylori infection in patients with duodenal ulcer may provoke reflux
esophagitis.
Gastroenterology.
1997;
112
1442-1447
MissingFormLabel
- 28
Vaezi M F, Falf G W. et al .
Cag
A-Positive strains of H. pylori may protect against Barrett‘s
esophagus.
Am J Gastroenterology.
2000;
95
2206-2211
MissingFormLabel
- 29
Parsonnet J, Friedmann G D, Vandersteen D P, Chang Y. et
al .
H. pylori infection and the risk of gastric carcinoma.
N
Engl J Med.
1991;
325
1127-1131
MissingFormLabel
- 30
Segal I.
The
gastro-oesophageal reflux disease complex in sub-Saharan Africa.
Eur
J Cancer Prev.
2001;
10
209-212
MissingFormLabel
- 31
Vaughan T L, Farrow D C, Hansten P D, Chow W H. et
al .
Risk of esophageal and gastric adenocarcinomas
in relation to use of calcium channel blockers, asthma drugs, and
other medications that promote gastroesophageal reflux.
Cancer
Epidemiol Biomarkers Prev.
1998;
7
749-756
MissingFormLabel
- 32
Lagergren J, Bergström R. et al. .
Association
between medications that relax the LES and risk for esophageal AC.
Ann
Intern Med.
2000;
133
165-175
MissingFormLabel
- 33
Wang H H, Hsieh C C, Antonioli D A.
Rising incidence of esophageal AC and use
of pharmaceutical agents that relax the lower esophageal sphinkter (USA).
Cancer
Causes Control.
1994;
5
573-578
MissingFormLabel
- 34
Brown L M, Swanson C A, Gridley G, Swanson G M, Schoenberg J B.
Adenocarcinoma of the esophagus.
Role of obesity and diet.
J National Cancer Inst.
1995;
87
104-109
MissingFormLabel
- 35
Chow W H, Blot W J, Vaughan T L, Risch H A. et
al .
BMI and risk of AC of the esophagus and gastric
cardia.
J Natl Cancer Inst.
1998;
90
150-155
MissingFormLabel
- 36
Lagergren J, Bergstrom R, Nyren O.
Association
between body mass and adenocarcinoma of the esophagus and gastric
cardia.
Ann Intern Med.
1999;
130
883-890
MissingFormLabel
- 37
Lagergren J, Bergstrom R, Nyren O.
No
relation between body mass and gastro-oesophageal reflux symptoms
in a Swedish population based study.
Gut.
2000;
47
26-29
MissingFormLabel
- 38
Kuczmarski R J, Flegal K M, Campbell S M, Johnson C L.
Increasing
prevalence of overweight among US adults.
JAMA.
1994;
272
205-211
MissingFormLabel
- 39
Levi F, Randimbison L, Lucchini F. et al .
Epidemiology of AC and squamous cell carcinoma
of the esophagus.
Eur J Cancer Prev.
2001;
10
91-96
MissingFormLabel
- 40
Mayne S T, Risch H A, Dubrow R, Chow W H, Gammon M D, Vaughan T L, Farrow D C. et al .
Nutrient intake
and risk of subtypes of esophageal and gastric cancer.
Cancer
Epidemiol Biomarkers Prev.
2001;
10
1055-1062
MissingFormLabel
Priv.-Doz. Dr. med. Hans Scherübl
Medizinische Klinik I, Gastroenterologie, Infektiologie & Rheumatologie, Universitätsklinikum
Benjamin Franklin, FU Berlin
Hindenburgdamm 30
12200
Berlin
Telefon: 0049/30/8445-3534
Fax: 0049/30/8445-4481
eMail: hscher@zedat.fu-berlin.de