Lau Melvin, Le Anne, El-Serag Hashem B
Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
Am J Gastroenterol. 2006 Nov;101(11):2485-92. doi: 10.1111/j.1572-0241.2006.00778.x. Epub 2006 Oct 4.
Noncardia gastric adenocarcinoma is not frequently mentioned in the United States. However, it is unclear if the previously reported decline in noncardia gastric adenocarcinoma has continued, and if detection and management has affected overall survival outside the setting of clinical trials.
We used the Surveillance, Epidemiology, and End Results registry (SEER) to identify all cases of noncardia gastric adenocarcinoma diagnosed between 1973 and 2002. The yearly age-adjusted incidence rates and the relative survival rates were calculated. Cox proportional hazards (PH) models were used to examine temporal trends from 1983 to 2003.
Between 1973 and 2002, there were 24,103 cases of noncardia gastric adenocarcinoma. The age-adjusted yearly incidence rate declined by 23% between 1973 and 2002 from 4.3 to 3.3 per 100,000 person-years. However, the incidence of localized noncardia gastric adenocarcinoma (invasive neoplasm confined to the organ of origin) remained without change between 0.9 and 1.0 per 100,000 person-years, and increased with age, especially in the 85+ yr age group (a 47% increase between 1973 and 2002). The incidence rates in men were double those in women, and 1.6-fold and 2.6-fold higher in blacks and other races (mostly Asians), respectively, compared with whites. Patients with radiation and chemotherapy after gastrectomy had a 22% better mortality risk compared with those treated with gastrectomy alone. The Cox PH analysis shows no significant change in mortality risk related to year of diagnosis between 1983 and 2002, both in unadjusted as well as adjusted analyses. However, there were significant independent regional and racial variations in survival. Asians had a 17% lower mortality risk compared with whites.
Despite the overall decline in noncardia gastric adenocarcinoma, the incidence of local stage disease has remained stable in most ages and even increased in old ages. Unfortunately, there has been no significant improvement in survival during the past 20 yr. Moreover, there remain considerable regional as well as racial variations in mortality.
非贲门部胃腺癌在美国并不常被提及。然而，此前报道的非贲门部胃腺癌发病率下降趋势是否持续，以及检测和治疗方法是否影响了临床试验以外的总体生存率，目前尚不清楚。
我们利用监测、流行病学和最终结果登记系统（SEER）确定了1973年至2002年间诊断出的所有非贲门部胃腺癌病例。计算了年龄调整后的年发病率和相对生存率。采用Cox比例风险（PH）模型研究了1983年至2003年的时间趋势。
1973年至2002年间，共有24,103例非贲门部胃腺癌病例。年龄调整后的年发病率从1973年的每10万人年4.3例降至2002年的每10万人年3.3例，下降了23%。然而，局限性非贲门部胃腺癌（局限于原发器官的浸润性肿瘤）的发病率在每10万人年0.9例至1.0例之间保持稳定，且随年龄增长而增加，尤其是在85岁及以上年龄组（1973年至2002年间增加了47%）。男性的发病率是女性的两倍，黑人和其他种族（主要是亚洲人）的发病率分别比白人高1.6倍和2.6倍。胃切除术后接受放疗和化疗的患者的死亡风险比仅接受胃切除术的患者低22%。Cox PH分析显示，在未经调整和调整后的分析中，1983年至2002年间与诊断年份相关的死亡风险均无显著变化。然而，生存率存在显著的独立地区和种族差异。亚洲人的死亡风险比白人低17%。
尽管非贲门部胃腺癌总体发病率下降，但大多数年龄段的局部疾病发病率保持稳定，甚至在老年人群中有所上升。不幸的是，在过去20年中生存率没有显著提高。此外，死亡率仍存在相当大的地区和种族差异。
