Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
Division of Surgical Oncology, Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
Ann Surg Oncol. 2017 Oct;24(11):3361-3367. doi: 10.1245/s10434-017-5992-2. Epub 2017 Jul 11.
In the United States, the overall survival rates for gastric adenocarcinoma have remained low, with surgical resection as the only therapy for many patients. Given the advances in multimodality treatment and the development of guidelines recommending adequate lymph node evaluation, the authors determined whether overall survival rates for patients with gastric adenocarcinoma have increased in the United States.
The study used the Surveillance Epidemiology and End Results (SEER) database to examine overall survival for patients with the diagnosis of gastric adenocarcinoma between 1988 and 2013. The study cohort was divided into five periods: 1988-1992, 1993-1997, 1998-2002, 2003-2007, and 2008-2013. Kaplan-Meier methods and Cox proportional hazards modeling were used to determine the effect that year of diagnosis had on overall survival.
The diagnosis was determined for 13,470 patients between 1988 and 2013. The use of radiation therapy and the proportion of patients who had at least 15 lymph nodes evaluated significantly increased during the study period. Unadjusted Kaplan-Meier estimates demonstrated significantly better survival rates for the patients with a diagnosis of gastric cancer in the later periods (2003-2007 and 2008-2013) than for those in the three earlier periods. In our Cox proportional hazards model, recent period was associated with a significantly lower hazard of 5-year mortality.
This analysis demonstrated for the first time that gastric cancer survival rates have significantly improved in the United States during the past 2 decades. This observation likely reflects improved adherence to cancer treatment guidelines, including adequate lymph node evaluation and delivery of adjuvant treatment more consistently.
在美国，胃腺癌的总体生存率一直较低，许多患者的唯一治疗方法是手术切除。鉴于多模式治疗的进步和推荐充分淋巴结评估的指南的发展，作者确定胃腺癌患者的总体生存率是否有所提高。
本研究使用监测、流行病学和最终结果（SEER）数据库，检查了 1988 年至 2013 年间被诊断为胃腺癌的患者的总体生存率。研究队列分为五个时期：1988-1992 年、1993-1997 年、1998-2002 年、2003-2007 年和 2008-2013 年。采用 Kaplan-Meier 方法和 Cox 比例风险模型确定诊断年份对总体生存率的影响。
1988 年至 2013 年间共诊断出 13470 例患者。在研究期间，放射治疗的使用和至少评估 15 个淋巴结的患者比例显著增加。未经调整的 Kaplan-Meier 估计表明，在后期（2003-2007 年和 2008-2013 年）诊断为胃癌的患者的生存率明显高于前三个时期。在我们的 Cox 比例风险模型中，最近的时期与 5 年死亡率的风险显著降低相关。
这项分析首次表明，在过去 20 年中，美国的胃癌生存率显著提高。这一观察结果可能反映了癌症治疗指南的更好遵循，包括更充分的淋巴结评估和更一致地提供辅助治疗。
