Stanford University School of Medicine, Stanford Cancer Center, 875 Blake Wilbur Dr, Stanford, CA 94025-5826, USA.
J Clin Oncol. 2012 Oct 1;30(28):3507-15. doi: 10.1200/JCO.2011.35.8028. Epub 2012 Sep 4.
In the United States, gastric cancer is rapidly fatal with a 25% 5-year survival. Of the few patients who survive, little is known about their demographic, clinical, and tumor characteristics.
Data regarding all cases of gastric and gastroesophageal junction (GEJ) adenocarcinoma diagnosed in California between 1988 and 2005 were obtained from the California Cancer Registry, a member of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. A Cox proportional hazards model was constructed to understand the independent relationships of patient demographic, disease, and treatment factors with survival.
We identified 47,647 patients diagnosed with gastric or GEJ cancer. Of those, only 9,325 (20%) survived at least 3 years. Variables associated with longer survival were localized stage (hazard ratio [HR], 0.20), surgery with diagnosis in 2002 or later (HR, 0.34), surgery with diagnosis in 2001 or before (0.37), regional stage (HR, 0.53), chemotherapy (HR, 0.56), intestinal histology (HR, 0.74), well- or moderately differentiated tumors (HR, 0.76), radiation (HR, 0.80), Asian/Pacific Islander race (HR, 0.81), treatment at an academic hospital (HR, 0.85), fundus/body/antrum location (HR, 0.90), highest socioeconomic status quintile (HR, 0.91), female sex (HR, 0.92), Hispanic race (HR, 0.92), and hospital size more than 150 beds (HR, 0.94). Kaplan-Meier curves showed longer median disease-specific survival (DSS) in patients with tumors originating in the fundus/body/antrum compared with esophagus/cardia (13.4 v 10.8 months). Intestinal histology had significantly longer median DSS (28.9 months) compared with other (11.0 months) or diffuse (10.1 months) histology.
Patients who survive gastric and GEJ cancer more than 3 years after diagnosis have demographic and pathologic characteristics distinct from those who do not survive.
在美国，胃癌的病死率很高，5 年生存率仅为 25%。在为数不多的存活患者中，人们对其人口统计学、临床和肿瘤特征知之甚少。
本研究从加利福尼亚癌症登记处获取了 1988 年至 2005 年间加利福尼亚诊断的所有胃和胃食管交界处（GEJ）腺癌病例的数据，加利福尼亚癌症登记处是美国国家癌症研究所监测、流行病学和最终结果（SEER）计划的成员之一。建立 Cox 比例风险模型以了解患者人口统计学、疾病和治疗因素与生存的独立关系。
我们共确定了 47647 例胃或 GEJ 癌症患者。其中，只有 9325 例（20%）至少存活 3 年。与更长生存时间相关的变量包括局部阶段（风险比 [HR]，0.20）、诊断时在 2002 年或之后进行的手术（HR，0.34）、诊断时在 2001 年或之前进行的手术（HR，0.37）、区域阶段（HR，0.53）、化疗（HR，0.56）、肠组织学（HR，0.74）、分化良好或中等的肿瘤（HR，0.76）、放疗（HR，0.80）、亚裔/太平洋岛民种族（HR，0.81）、在学术医院接受治疗（HR，0.85）、胃底/体/窦部位（HR，0.90）、最高社会经济地位五分位数（HR，0.91）、女性（HR，0.92）、西班牙裔（HR，0.92）和床位数超过 150 张的医院（HR，0.94）。Kaplan-Meier 曲线显示，起源于胃底/体/窦的肿瘤患者的中位疾病特异性生存率（DSS）明显长于起源于食管/贲门的患者（13.4 个月比 10.8 个月）。肠组织学的中位 DSS 明显长于其他组织学（11.0 个月）或弥漫性组织学（10.1 个月）。
在诊断后 3 年以上存活的胃和 GEJ 癌患者具有与未存活患者不同的人口统计学和病理特征。
