Bringeland Erling A, Wasmuth Hans H, Mjønes Patricia, Myklebust Tor Å, Grønbech Jon E
a Department of Gastrointestinal Surgery , St. Olavs Hospital, Trondheim University Hospital , Trondheim , Norway.
b Department of Pathology , St. Olavs Hospital, Trondheim University Hospital , Trondheim , Norway.
Acta Oncol. 2017 Jan;56(1):39-45. doi: 10.1080/0284186X.2016.1227086. Epub 2016 Oct 6.
Population-based studies for gastric adenocarcinoma are scarce, particularly studies conducted within a defined geographical area with publicly available censuses that allow incidence rates to be calculated.
Population-based study in Central Norway from 2001 to 2011, covering a population of 636 000-680 000, respectively. Patients were identified through the Cancer Registry of Norway and the Norwegian Patient Register, and were characterized by data from individual electronic patient records. Outcomes were compared across the early and the late half of the study period.
A total of 878 patients were identified with a median age of 76.2 years. The male to female ratio was 1.72. Annual world age-standardized incidence was 8.0/10 and 3.6/10, respectively. The Lauren diffuse type was significantly more frequent among patients below 60 years, among females and for non-cardia cancers, compared to their counterparts (p < .001). The Lauren mixed type had a stable proportion of around 13% irrespective of age, sex or tumor location. Early gastric cancers (EGC) represented 8.3% of the cases, whereas 44% of all patients were diagnosed with metastatic disease. In males, the proportion of cardia cancers increased from 29.7% to 39.1% during the study period (p = .005). The five-year overall survival was 16%, and was substantially better for the Lauren intestinal type compared to the diffuse type, log-rank p = .003. The R0-R1 resection rate was 39%, with a corresponding five-year survival of 40.9%.
This study provides population-derived data lacking in hospital-based studies. Lauren categories with epidemiological aspects and clinical outcomes are displayed. Gastric cancer was associated with a dismal prognosis. Few patients had EGC and close to 50% had metastatic disease. Many were too old or frail to be considered for surgery.
基于人群的胃癌研究较少，尤其是在具有公开可用人口普查数据、能够计算发病率的特定地理区域内开展的研究。
对2001年至2011年挪威中部地区进行基于人群的研究，研究对象分别涵盖63.6万至68万人口。通过挪威癌症登记处和挪威患者登记处识别患者，并依据个体电子病历数据进行特征描述。对研究期前半段和后半段的结果进行比较。
共识别出878例患者，中位年龄为76.2岁。男女比例为1.72。年度世界年龄标准化发病率分别为8.0/10万和3.6/10万。与其他患者相比，60岁以下患者、女性患者以及非贲门癌患者中劳伦弥漫型更为常见（p＜0.001）。无论年龄、性别或肿瘤位置如何，劳伦混合型的比例稳定在13%左右。早期胃癌（EGC）占病例的8.3%，而所有患者中有44%被诊断为转移性疾病。在男性中，研究期间贲门癌的比例从29.7%增至39.1%（p = 0.005）。五年总生存率为16%，劳伦肠型的生存率显著高于弥漫型，对数秩检验p = 0.003。R0 - R1切除率为39%，相应的五年生存率为百分之40.9。
本研究提供了基于人群的数据，这是基于医院的研究中所缺乏的。展示了具有流行病学特征和临床结果的劳伦分类。胃癌预后不佳。很少有患者为早期胃癌，近50%的患者患有转移性疾病。许多患者年龄过大或身体过于虚弱，无法考虑手术治疗。
