Global patterns of upper gastrointestinal cancer incidence by subtype and subsite in 2022: a population-based study

To provide an updated global assessment of esophageal and gastric cancers incidence by histological subtype and anatomical subsite. We utilized data from GLOBOCAN 2022 and Cancer Incidence in Five Continents Vol. XII (2013-2017) to estimate the incidence of esophageal cancer subtypes (squamous cell carcinoma [ESCC] and adenocarcinoma [EAC]) and gastric cancer subsites (cardia [CGC] and non-cardia [NCGC]). Age-standardized incidence rates (ASIRs) were calculated by sex for each country, world region, and Human Development Index (HDI) category. Spearman correlation analysis was conducted to evaluate the association between ASIRs and HDI. In 2022, an estimated 511,000 new esophageal cancer cases occurred globally (83% ESCC [ASIR 4.1 per 100,000 person-years], 16% EAC [ASIR 0.8]), with Eastern Asia accounting for 53% of global ESCC and 25% of EAC cases. Among 968,000 gastric cancer cases, 13% were CGC (ASIR 1.2 per 100,000 person-years) and 87% were NCGC (ASIR 8.0), with Eastern Asia contributing 44% and 55% of CGC and NCGC cases, respectively. Notably, age-stratified analyses revealed a distinct burden of early-onset disease (<50 years) in South-Central Asia, which accounted for 57% of global early-onset ESCC and 35% of early-onset EAC cases. Generally, EAC incidence exceeded that of ESCC in Northern and Western Europe, Northern America, and Oceania. More than 50% of global EAC cases occurred in countries with very high HDI. Incidence rates were consistently higher among males than females, with particularly elevated male-to-female ASIR ratios for EAC (up to 7.0) and CGC (up to 4.7). ESCC and NCGC represent the most prevalent upper gastrointestinal cancer subtypes globally, with Eastern Asia accounting for the highest burden. Crucially, South-Central Asia has emerged as a key region for early-onset esophageal cancer (<50 years). The region-, sex-, and age-specific variations in incidence underscore the necessity for targeted prevention strategies to reduce the global burden of these cancers.