采用国际验证的列线图比较美国和韩国 R0 切除术后胃癌的生存情况。

Comparison of gastric cancer survival following R0 resection in the United States and Korea using an internationally validated nomogram.

机构信息

Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.

出版信息

Ann Surg. 2010 Apr;251(4):640-6. doi: 10.1097/SLA.0b013e3181d3d29b.

DOI:10.1097/SLA.0b013e3181d3d29b

PMID:20224369

Abstract

OBJECTIVE

To compare disease-specific survival (DSS) between the US and Korea following R0 resection for gastric carcinoma (GC).

SUMMARY BACKGROUND DATA

Many studies have described decreased 5-year survival after curative gastrectomy for GC in the West compared with the East. Although clinicopathological presentations of GC are known to vary widely between Eastern and Western countries, including histology, tumor location, and stage at presentation, it remains unclear whether these factors account for differences in survival.

METHODS

All patients undergoing curative intent resections (R0) for GC (1995-2005) were evaluated in 2 independent, single-institution prospectively maintained databases from the US (711 patients) and Korea (1646 patients). Patients receiving neoadjuvant chemotherapy were excluded from this analysis. Patient, surgical and pathologic variables were compared. DSS was determined via multivariate analysis using prognostic variables from an internationally validated GC nomogram that estimates the probability of 5- and 9-year survival.

RESULTS

Age and body mass index were significantly higher in US patients. Location of tumors was more often proximal in the United States (39% vs. 9%, P < 0.0001) and distal in Korea (54% vs. 33%, P < 0.0001). Korean patients had more early stage tumors (42% vs. 28% stage Ia, P < 0.0001) with a higher number of lymph nodes identified (97% vs. 79%, >or=15 lymph nodes, P < 0.0001). The 5-year DSS was higher in Korea than in the United States. After multivariate analysis, applying factors used in the nomogram, DSS of Korean GC patients remained significantly better than that of US patients (HR = 1.3, 95% CI; 1.0-1.6, P = 0.008).

CONCLUSIONS

This study demonstrates better survival for GC patients in Korea compared with the US as determined by multivariate analysis with a validated gastric cancer nomogram. Multiple possibilities can explain this difference.

摘要

目的

比较美国和韩国行根治性切除术（R0 切除）后胃癌患者的疾病特异性生存率（DSS）。

摘要背景数据

许多研究表明，与东方国家相比，西方国家行根治性胃切除术治疗胃癌后，5 年生存率下降。尽管胃癌的临床病理表现，包括组织学、肿瘤位置和发病时的分期，在东西方国家之间存在很大差异，但尚不清楚这些因素是否导致了生存率的差异。

方法

评估了来自美国（711 例患者）和韩国（1646 例患者）的 2 个独立的、单机构前瞻性维护数据库中所有接受根治性切除术（R0 切除）治疗的胃癌（1995-2005 年）患者。排除接受新辅助化疗的患者。比较患者、手术和病理变量。通过使用国际验证的胃癌列线图来预测 5 年和 9 年生存率的预后变量的多变量分析来确定 DSS。

结果

美国患者的年龄和体重指数明显较高。肿瘤位置在美国更常为近端（39%比 9%，P < 0.0001），而在韩国更常为远端（54%比 33%，P < 0.0001）。韩国患者的早期肿瘤比例更高（42%比 28%，Ia 期，P < 0.0001），淋巴结检出数量更多（97%比 79%，>或=15 个淋巴结，P < 0.0001）。韩国的 5 年 DSS 高于美国。多变量分析后，应用列线图中的因素，韩国胃癌患者的 DSS 仍显著优于美国患者（HR = 1.3，95%CI；1.0-1.6，P = 0.008）。