INTRODUCTION Upper gastrointestinal (UGI) cancers, comprising malignancies of the esophagus, stomach, duodenum, pancreas, liver, biliary tract, and gallbladder, are the second leading cause of cancer-related mortality in the United States and are associated with significant comorbidities. Recent studies show a disproportionate rise in pancreatic and stomach cancer among young adults. This study aims to use a nationwide, population-based cohort to (i) evaluate the trend of all UGI cancer as an aggregate and (ii) examine the role of demographics, histology, and tumor stage in UGI cancer incidence among young adults. METHODS Individuals diagnosed with UGI cancer in the United States from 2001 to 2019 were identified and obtained from the Surveillance, Epidemiology, and End Results-National Program of Cancer Registries database. The primary outcomes were incidence rates of UGI cancer (calculated per 100,000, age-adjusted to the year 2000 US population), stratified by sex and age (< 55 years for young adults and ≥ 55 years for older adults). Trends, annual percentage change, and average annual percentage change were calculated using the parametric method. Sensitivity analysis was performed according to primary site and histology; further analysis examining race and cancer stage was performed in the young adult subgroup. RESULTS A total of 2,333,161 patients with UGI cancer were identified. Most cases were male, and 14.3% were < 55 years of age. Incidence of UGI cancer increased most in women younger than 55 years, driven primarily by pancreatic and stomach cancers, as well as neuroendocrine tumor and gastrointestinal stromal tumor histology. African American race and localized tumors and malignancy with distant spread are also contributing to the disparate increase among young women. UGI mortality rates have not changed significantly in young adults. DISCUSSION The overall incidence rate of upper gastrointestinal cancer is increasing significantly in young women compared with men. Increased endoscopic procedures and disparate exposure to risk factors are likely contributing to these trends.

中文翻译：

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年轻人上消化道癌的发病率趋势：使用 2001-2019 年美国癌症统计数据库的全国时间趋势分析。


引言 上消化道 （UGI） 癌症，包括食管、胃、十二指肠、胰腺、肝脏、胆道和胆囊的恶性肿瘤，是美国癌症相关死亡的第二大原因，并与严重的合并症有关。最近的研究表明，年轻人患胰腺癌和胃癌的发病率不成比例地增加。本研究旨在使用全国性的、基于人群的队列来 （i） 评估所有 UGI 癌症的总体趋势，以及 （ii） 检查人口统计学、组织学和肿瘤分期在年轻人 UGI 癌症发病率中的作用。方法 从 2001 年至 2019 年在美国诊断患有 UGI 癌症的个体被确定并获得 监测、流行病学和最终结果 - 国家癌症登记计划数据库。主要结局是上消化道癌症的发病率（每 100,000 人计算，年龄调整为 2000 年美国人口），按性别和年龄分层（< 年轻人 55 岁，老年人 ≥ 55 岁）。使用参数方法计算趋势、年度百分比变化和平均年度百分比变化。根据原发部位和组织学进行敏感性分析;在年轻成人亚组中进行了进一步分析，检查了种族和癌症分期。结果 共确定 2,333,161 例 UGI 癌患者。大多数病例为男性，14.3% 为 < 55 岁。55 岁以下女性的 UGI 癌发病率增加最多，主要由胰腺癌和胃癌以及神经内分泌肿瘤和胃肠道间质瘤组织学驱动。 非裔美国人种族和局部肿瘤以及远距离扩散的恶性肿瘤也导致年轻女性的不同增长。年轻人的 UGI 死亡率没有显着变化。讨论 与男性相比，年轻女性的上消化道癌总发病率显著增加。内窥镜手术的增加和对风险因素的不同暴露可能是促成这些趋势的原因。