Fayçal Joseph, Bessaguet Christophe, Nousbaum Jean-Baptiste, Cauvin Jean-Michel, Cholet Franck, Bideau Karine, Robaszkiewicz Michel, Gouérou Hervé
Service d'Hépato-Gastroentérologie, CHU La Cavale Blanche, 29609 Brest Cedex, France.
Gastroenterol Clin Biol. 2005 Jan;29(1):23-32. doi: 10.1016/s0399-8320(05)80690-6.
The aims of this study were to evaluate trends in incidence, clinical characteristics, treatment regimen and prognosis of gastric carcinoma in the area of Finistere (France) during a 12-year period.
Between 1984 and 1995, the Finistere Registry of GastroIntestinal Tract Tumors listed 2 139 patients with gastric carcinoma in a population of 838 627 inhabitants. Curative resection and operative mortality were analyzed by logistic regression. Prognostic factors were determined using the Kaplan-Meier method and the Cox model.
When comparing the second period (1990-1995) to the first period (1984-1989) we observed: a) a decrease of standardized incidence (13.2 vs. 15.6/100 000 inhabitants/year in males and 5.4 vs. 7.0/100 000 inhabitants/year in females); b) a significant increase of linitis plastica (21.4% vs. 10.9%) and infiltrative tumors (53.1 vs. 31.2%) (P<0.0001); c) no variation in tumor stage at diagnosis; d) a significant increase in curative resection (65.7% vs. 45.0%; P<0.0001); e) no variation in operative mortality; f) the absence of improvement of survival rate; the latter was 29% at 2 years, 19% at 5 years and 11% at 10 years during the second period. Multivariate analysis showed that the main prognostic factors of gastric carcinoma were age, tumor stage and the type of surgical procedure.
This study showed a decrease in the incidence of gastric carcinoma over time and an increase of linitis plasticia and infiltrative forms. Despite improvement in management of patients, the global prognosis of gastric carcinoma did not improve significantly over a 12-year period of observation.
本研究旨在评估在12年期间，法国菲尼斯泰尔地区胃癌的发病率、临床特征、治疗方案及预后的变化趋势。
1984年至1995年期间，菲尼斯泰尔胃肠道肿瘤登记处列出了838627名居民中的2139例胃癌患者。采用逻辑回归分析根治性切除率和手术死亡率。使用Kaplan-Meier法和Cox模型确定预后因素。
将第二个时期（1990 - 1995年）与第一个时期（1984 - 1989年）进行比较时，我们观察到：a）标准化发病率下降（男性从15.6/10万居民/年降至13.2/10万居民/年，女性从7.0/10万居民/年降至5.4/10万居民/年）；b）皮革胃（21.4%对10.9%）和浸润性肿瘤（53.1对31.2%）显著增加（P<0.0001）；c）诊断时肿瘤分期无变化；d）根治性切除率显著提高（65.7%对45.0%；P<0.0001）；e）手术死亡率无变化；f）生存率没有提高；在第二个时期，2年生存率为29%，5年生存率为19%，10年生存率为11%。多因素分析表明，胃癌的主要预后因素是年龄、肿瘤分期和手术方式。
本研究表明，随着时间的推移，胃癌发病率下降，皮革胃和浸润性形式增加。尽管患者管理有所改善，但在12年的观察期内，胃癌的总体预后并未显著改善。
