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Background and objective: Esophageal cancer (EC) is the seventh most prevalent cancer globally and the sixth leading cause of cancer-related mortality. This study aimed to provide an updated stratified assessment of rates in EC incidence, mortality, and disability-adjusted life-years (DALYs) from 1990 to 2021 by sex, age, and Socio-demographic Index (SDI) at global, regional, and national levels, as well as to project the future trends of EC both globally and regionally. Methods: Data about age-standardized rates (ASRs) of incidence (ASIR), mortality (ASDR), probability of death (ASPoD) and DALYs (ASDALYRs) of EC were obtained from the 2021 Global Burden of Disease (GBD) study. Estimated annual percentage changes (EAPCs) and average annual percentage changes (AAPC) were calculated over certain periods to describe the temporal trends of EC burdens. The analyses were disaggregated by sexes, GBD super-regions and regions, nations/territories, age-groups, and SDI quintiles. A Bayesian age-period-cohort (BAPC) model was constructed to project the global and regional EC ASRs in 2022–2035. Results: Despite global reductions in EC ASRs, with ASIR, ASDR, and ASDALYR in 2021 of 6.65 [5.88, 7.45] (95% uncertainty interval), 6.25 [5.53, 7.00], and 148.56 [131.71, 166.82], decreasing by 24.9%, 30.7%, and 36.9% in 1990–2021, respectively, the absolute burden numbers were increased from 1990 to 2021, probably because of population growth and aging. Global newly diagnosed cases, deaths, and DALYs of EC increased to 576,529 [509,492, 645,648], 356,263 [319,363, 390,154], and 12,999,265 [11,522,861, 14,605,268] in 2021, by 62.53%, 51.18%, and 33.28% compared to records in 1990. The geographical pattern of EC was consistent: locations with the highest EC incidence and mortality rates were predominantly located in the Asian Esophageal Cancer Belt and African Esophageal Cancer Corridor, with East Asia, Southern Sub-Saharan Africa, and Eastern Sub-Saharan Africa as the GBD regions with the heaviest EC burdens, and Malawi, Eswatini, Mongolia, Zambia, and Zimbabwe with the most EC ASRs in 2021. However, owing to the population size, China, India, the United States, Japan, and Brazil had the heaviest absolute EC burdens. More pronounced alleviations of ASRs were observed in locations with high SDI levels, indicated by their lower AAPC values compared to those of low-SDI locations, while Sub-Saharan Africa regions had increasing EC ASRs, especially in Chad (114.76% in ASDR, for example), Sao Tome and Principe (97.93%), Togo (92.53%), Northern Mariana Islands (84.32%), Liberia (82.33%), etc. Smoking remained the leading contributor to EC ASDALYR globally and across most GBD super-regions in 2021. The EC burden is significantly heavier for males, with incidence and mortality in males in 2021 being 2.89 and 2.88 times higher, respectively, than in females. Across all age groups, EC posed an increasingly significant threat to men aged > 75 years. From 2022 to 2035, the ASR projections show only modest decrease in both global and regional EC burdens, and the absolute burden numbers are expected to increase globally and in nearly all GBD super-regions. Conclusion: EC burden remains significant, with disparities across sexes, age groups, and regions. Region-specific and age-targeted measures are crucial to addressing these inequalities, especially in light of increasing EC burdens in older men and in African regions. Efforts should be taken in finding more solid attributions to risk factors for EC burdens and to better identify high-risk populations to inform targeted prevention and screening, and ultimately reduce the EC burden in an efficient and cost-effective way. [ABSTRACT FROM AUTHOR]

STUDY QUESTION Do obstetric and perinatal complications vary according to different blastocyst developmental parameters after frozen-thawed single-blastocyst transfer (SBT) cycles? SUMMARY ANSWER Pregnancies following the transfer of a blastocyst with a grade C trophectoderm (TE) were associated with an increased risk of placenta previa compared to those with a blastocyst of grade A TE. WHAT IS KNOWN ALREADY Existing studies investigating the effect of blastocyst morphology grades on birth outcomes have mostly focused on fetal growth and have produced conflicting results, while the risk of obstetric complications has rarely been reported. Additionally, growing evidence has suggested that the appearance of TE cells could serve as the most important parameter for predicting implantation and live birth. Given that the TE ultimately develops into the placenta, it is plausible that this independent predictor may also impact placentation. STUDY DESIGN, SIZE, DURATION This retrospective cohort study at a tertiary-care academic medical center included 6018 singleton deliveries after frozen-thawed SBT cycles between January 2017 and December 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS Singleton pregnancies were grouped into two groups according to blastocyst developmental stage (Days 5 and 6), four groups according to embryo expansion (Stages 3, 4, 5, and 6), three groups according to inner cell mass (ICM) quality (A, B, and C), and three groups according to TE quality (A, B, and C). The main outcomes included pregnancy-induced hypertension, preeclampsia, gestational diabetes mellitus, preterm premature rupture of membrane, placenta previa, placental abruption, placenta accreta, postpartum hemorrhage, preterm birth, low birth weight, small for gestational age, and birth defects. Multivariate logistic regressions were performed to evaluate the effect of blastocyst developmental stage, embryo expansion stage, ICM grade, and TE grade on measured outcomes adjusting for potential confounders. MAIN RESULTS AND THE ROLE OF CHANCE No association was found between blastocyst developmental stage and obstetric or perinatal outcomes both before and after adjusting for potential confounders, and similar results were found with regard to embryo expansion stage and ICM grade. Meanwhile, the incidence of placenta previa derived from a blastocyst with TE of grade C was higher compared with those derived from a blastocyst with TE of grade A (1.7%, 2.4%, and 4.0% for A, B, and C, respectively, P  =   0.001 for all comparisons). After adjusting for potential covariates, TE grade C blastocysts had 2.81 times the likelihood of resulting in placenta previa compared to TE grade A blastocysts (adjusted odds ratio 2.81, 95% CI 1.11–7.09). No statistically significant differences were detected between any other measured outcomes and TE grades both before or after adjustment. LIMITATIONS, REASONS FOR CAUTION The study is limited by its retrospective, single-center design. Additionally, although the sample size was relatively large for the study group, the sample size for certain subgroups was relatively small and lacked adequate power, particularly the ICM grade C group. Therefore, these results should be interpreted with caution. WIDER IMPLICATIONS OF THE FINDINGS The study extends our knowledge of the potential downstream effect of TE grade on placental abnormalities. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by the National Key Research and Development Program of China (2023YFC2705500, 2023YFC2705501, 2023YFC2705505, 2019YFA0802604); National Natural Science Foundation of China (82130046, 82320108009, 82371660, 32300710); Shanghai leading talent program, Innovative research team of high-level local universities in Shanghai (SHSMU-ZLCX20210201, SHSMU-ZLCX20210200, SHSMU-ZLCX20180401), Shanghai Jiaotong University School of Medicine Affiliated Renji Hospital Clinical Research Innovation Cultivation Fund Program (RJPY-DZX-003), Science and Technology Commission of Shanghai Municipality (23Y11901400), Shanghai's Top Priority Research Center Construction Project (2023ZZ02002), and Three-Year Action Plan for Strengthening the Construction of the Public Health System in Shanghai (GWVI-11.1-36). The authors have no conflicts of interest to declare. TRIAL REGISTRATION NUMBER N/A. [ABSTRACT FROM AUTHOR]