Herbreteau Elodie, Jooste Valérie, Hamza Samia, Lepage Côme, Faivre Jean, Bouvier Anne-Marie
Digestive Cancer Registry of Burgundy INSERM U866, University Hospital, University of Burgundy, BP 87 900, 21079, Dijon Cedex, France.
Gastric Cancer. 2015 Jan;18(1):129-37. doi: 10.1007/s10120-014-0342-6. Epub 2014 Feb 1.
Gastric cancer is still generating interest because of its poor prognosis. The aim of this study was to investigate time trends in diagnostic assessment, patterns of care, and survival of gastric cancers.
We considered 5,010 gastric cancers diagnosed between 1976 and 2007 in a well-defined French population. Logistic regressions were used to identify factors associated with R0 resection and operative mortality. A multivariate relative survival analysis was performed.
Diagnostic modalities have changed. Since 1988, endoscopy is performed when gastric cancer is suspected (95.5%). However, there has been no strong variation in stage over time: the proportion of stage I cancers increased from 5.5% to 13.4% between the periods 1976-1979 and 2004-2007 (p < 0.001) whereas that of advanced cases remained stable, 64.8% and 65.0%, respectively. R0 resections rose from 36.7% (1976-1979) to 46.7% between 1980 and 1999, and decreased to 32.7% thereafter. Age, tumor location, and period were associated with R0 resection. Neoadjuvant and adjuvant chemotherapy were rarely used before 2000, then reached 15.0% and 19.1%, respectively, during the later period. Operative mortality after R0 resection decreased from 18.3% during the 1976-1979 period to 4.3% during the 2004-2007 period (p < 0.001). Prognosis slightly improved during the three first periods, from 13.0% to 22.6%, then leveled off, not exceeding 26.0% thereafter. Stage, age, histology, and time period significantly influenced survival.
Changes in diagnostic modalities were associated with minor changes in stage and prognosis for gastric cancer. Earlier diagnosis and new therapeutic strategies are the best way to improve the prognosis.
由于胃癌预后较差，其仍备受关注。本研究旨在调查胃癌诊断评估、治疗模式及生存情况的时间趋势。
我们纳入了1976年至2007年间在法国一个明确界定的人群中诊断出的5010例胃癌患者。采用逻辑回归分析确定与R0切除及手术死亡率相关的因素。进行了多变量相对生存分析。
诊断方式发生了变化。自1988年以来，怀疑患有胃癌时即进行内镜检查（95.5%）。然而，分期随时间变化不大：I期癌症的比例在1976 - 1979年期间至2004 - 2007年期间从5.5%增至13.4%（p < 0.001），而晚期病例的比例分别保持稳定，为64.8%和65.0%。R0切除率从1976 - 1979年的36.7%升至1980年至1999年期间的46.7%，此后降至32.7%。年龄、肿瘤位置和时期与R0切除相关。2000年前新辅助化疗和辅助化疗很少使用，后期分别达到15.0%和19.1%。R0切除术后的手术死亡率从1976 - 1979年期间的18.3%降至2004 - 2007年期间的4.3%（p < 0.001）。在最初三个时期预后略有改善，从13.0%升至22.6%，随后趋于平稳，此后未超过26.0%。分期、年龄、组织学类型和时期显著影响生存。
诊断方式的改变与胃癌分期和预后的微小变化相关。早期诊断和新的治疗策略是改善预后的最佳途径。
