title: Long-term trends and survival analysis of esophageal and gastric cancer in Yangzhong, 1991-2013.
abstract: OBJECTIVE
  To describe the long-term trends of the incidence, mortality and survival of upper digestive tract cancers in a high-risk area of China.
  
  
  METHODS
  We extracted esophageal and gastric cancer cases diagnosed from 1991 to 2013 through the Yangzhong Cancer Registry and calculated the crude and age-standardized incidence and mortality rates. Cancer trends were calculated using the Joinpoint Regression Program and were reported using the annual percentage change (APC). The cancer-specific survival rates were evaluated and compared between groups using the Kaplan-Meier method and log-rank test.
  
  
  RESULTS
  The age-standardized incidence rate of esophageal cancer declined from 107.06 per 100,000 person-years (male: 118.05 per 100,000 person-years; female: 97.42 per 100,000 person-years) in 1991 to 37.04 per 100,000 person-years (male: 46.43 per 100,000 person-years; female: 27.26 per 100,000 person-years) in 2013, with an APC of -2.5% (95% confidence interval (CI): -3.4%, -1.5%) for males and -4.9% (95% CI:-5.8%, -3.9%) for females. The age-standardized incidence rate of gastric cancer was 165.11 per 100,000 person-years (male: 225.39 per 100,000 person-years; female: 113.34 per 100,000 person-years) in 1991 and 53.46 per 100,000 person-years (male: 76.51 per 100,000 person-years; female: 32.43 per 100,000 person-years) in 2013, with the APC of -3.6% (95% CI: -4.5%, -2.7%) for males and -4.8% (95% CI: -5.7%, -3.9%) for females. The median survival time was 3.0 years for patients with esophageal or gastric cancer. Cancer cases detected after 2004 had a better prognosis.
  
  
  CONCLUSIONS
  The age-standardized incidence rates of both esophageal and gastric cancer continuously decreased since 1991 through 2013, whereas the mortality rate remained stable before 2004 and significantly declined following the massive endoscopic screening program initiated in 2004. The survival probability of patients with esophageal and gastric cancer has improved obviously in recent decades.
authors.affiliation: Department of Epidemiology, Yangzhong Cancer Research Institute, Yangzhong, China.|Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China.
authors.forename: Zhaolai
authors.initials: Z
authors.lastname: Hua
authors.affiliation: Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China.
authors.forename: Xianzhi
authors.initials: X
authors.lastname: Zheng
authors.affiliation: Department of Thoracic Surgery, People's Hospital of Yangzhong, Yangzhong, China.
authors.forename: Hengchuan
authors.initials: H
authors.lastname: Xue
authors.affiliation: Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, China.|The Innovation Center for Social Risk Governance in Health, School of Public Health, Nanjing Medical University, Nanjing, China.
authors.forename: Jianming
authors.identifier: http://orcid.org/0000-0002-9151-284X
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Gastroenterology, Zhenjiang First People's Hospital, Zhenjiang, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Yao
mesh_terms: D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D004938:Esophageal Neoplasms / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000401:mortality*; D016019:Survival Analysis