O'connell Jessica B, Maggard Melinda A, Liu Jerome H, Etzioni David A, Ko Clifford Y
Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, 10833 Le Conte Avenue, Room 72-215 CHS, Los Angeles, California 90095, USA.
J Surg Res. 2004 Oct;121(2):214-21. doi: 10.1016/j.jss.2004.04.002.
Longitudinal analyses of cancer registries provide an opportunity for population-based explanations of epidemiology and survival-related outcomes. This study used two population-based data sets to report on nine surgery-related cancers over the past three decades.
Using the SEER cancer database (1973-1999), all patients (>18 years old) with adenocarcinoma of esophagus, gastric, biliary system, pancreas, small bowel, colon, rectum; esophageal squamous cell carcinoma (ESC), or hepatocellular (HCC) carcinoma (n = 379,640) were analyzed. Changes in incidence rates, stage at diagnosis, and 5-year cancer and stage-specific survivals were determined. A separate database, the California inpatient database (1990-2000), was concurrently used to evaluate inpatient mortality after surgical resection (n = 34,057).
Incidence rates increased for three cancers (esophageal, HCC, small bowel); decreased for three (rectal, gastric, ESC); and stayed constant for three (biliary, pancreatic, colon). More patients presented with local/regional disease in the 1990s versus 1970s for eight tumors (except small bowel, P < 0.05). Five-year overall survival improved for all but small bowel (P < 0.05); and local stage survival was improved for all except small bowel and biliary (P < 0.05). Finally, inpatient mortality rates improved significantly for liver, esophageal, pancreatic, and gastric resections (P < 0.05) over the past decade.
For these nine surgically treated cancers, we are detecting disease at earlier and therefore more treatable stages, and surgical care and outcomes also appear to have improved. Continued reexamination of longitudinal trends of surgically relevant outcomes is important for future improvement of surgical care.
癌症登记处的纵向分析为基于人群的流行病学和生存相关结果的解释提供了机会。本研究使用两个基于人群的数据集报告了过去三十年中九种与手术相关的癌症情况。
使用监测、流行病学和最终结果（SEER）癌症数据库（1973 - 1999年），对所有年龄大于18岁的患有食管癌、胃癌、胆道系统癌、胰腺癌、小肠癌、结肠癌、直肠癌的腺癌患者；食管鳞状细胞癌（ESC）或肝细胞癌（HCC）（n = 379,640）进行分析。确定发病率、诊断时的分期、5年癌症生存率和特定分期生存率的变化。同时使用另一个数据库，即加利福尼亚住院患者数据库（1990 - 2000年）来评估手术切除后的住院死亡率（n = 34,057）。
三种癌症（食管癌、肝细胞癌、小肠癌）的发病率上升；三种癌症（直肠癌、胃癌、食管鳞状细胞癌）的发病率下降；三种癌症（胆道癌、胰腺癌、结肠癌）的发病率保持不变。与20世纪70年代相比，20世纪90年代有八种肿瘤（小肠癌除外，P < 0.05）的局部/区域疾病患者更多。除小肠癌外，所有癌症的5年总生存率均有所提高（P < 0.05）；除小肠癌和胆道癌外，所有癌症的局部分期生存率均有所提高（P < 0.05）。最后，在过去十年中，肝脏、食管、胰腺和胃切除术的住院死亡率显著改善（P < 0.05）。
对于这九种接受手术治疗的癌症，我们在更早且因此更可治疗的阶段发现疾病，并且手术护理和结果似乎也有所改善。持续重新审视手术相关结果的纵向趋势对于未来手术护理的改善很重要。
