Dutta Roy Subhajit, Kupp Daniel V, Slavin John P, Corless David J, Deakin Mark
Research Unit, Department of Surgery, Leighton Hospital, South Cheshire, Birmingham, United Kingdom.
Surgery. 2005 Nov;138(5):859-68. doi: 10.1016/j.surg.2005.04.018.
It is postulated that patients with upper gastrointestinal cancers from affluent classes have better survival outcomes than those from deprived backgrounds. We aimed to analyze the incidence, mortality, and survival trends of esophageal, gastric, and pancreatic cancers in West Midlands, England, from 1986 to 2000 in terms of socioeconomic deprivation.
A well-validated demographic score, the Townsend Band, was employed as a measure of socioeconomic status. Data were collated from a cancer registry database; the individuals were allocated to 1 of 5 Townsend bands by using the postcodes at diagnosis. Relative survival rates were calculated by using stratified actuarial life tables, regression trend analysis at 1 and 5 years was performed, and the P value was derived from a t test statistic.
An increase in esophageal cancer incidence was more marked in the affluent categories (127%), compared with the deprived categories (57%). Gastric cancer incidence fell preferentially by 31% and 47% in the most-deprived men and women, respectively, but remained relatively unchanged in the affluent groups. A marginal overall decrease in pancreatic cancer incidence masked preferential increases in the most-affluent men (39%) and women (41%). Small increases in 1- and 5-year survival were noted in affluent subgroups, with the 1-year survival advantage for esophageal cancer achieving significant levels in the most-affluent categories (P = .05).
The esophageal cancer incidence increased preferentially in the affluent groups but with a marginally better survival rate. The gastric cancer incidence decreased noticeably in the most-deprived groups, suggesting that improvements in hygiene with consequent reduction in Helicobacter pylori primarily could be responsible. Pancreatic cancer trends were unrelated to social deprivation and warrant further studies.
据推测，来自富裕阶层的上消化道癌症患者比来自贫困背景的患者有更好的生存结果。我们旨在分析1986年至2000年期间，英格兰西米德兰兹地区食管癌、胃癌和胰腺癌在社会经济剥夺方面的发病率、死亡率和生存趋势。
采用经过充分验证的人口统计学评分汤森德等级作为社会经济地位的衡量标准。数据从癌症登记数据库中整理而来；根据诊断时的邮政编码，将个体分配到5个汤森德等级中的1个。使用分层精算生命表计算相对生存率，进行1年和5年的回归趋势分析，并从t检验统计量得出P值。
与贫困类别（57%）相比，富裕类别中食管癌发病率的增加更为显著（127%）。最贫困的男性和女性胃癌发病率分别优先下降了31%和47%，但富裕群体中相对保持不变。胰腺癌发病率总体略有下降，掩盖了最富裕男性（39%）和女性（41%）优先增加的情况。富裕亚组中1年和5年生存率有小幅提高，食管癌的1年生存优势在最富裕类别中达到显著水平（P = 0.05）。
富裕群体中食管癌发病率优先增加，但生存率略有提高。最贫困群体中胃癌发病率明显下降，这表明卫生条件改善导致幽门螺杆菌感染减少可能是主要原因。胰腺癌趋势与社会剥夺无关，值得进一步研究。
