丹麦 2004 年至 2013 年期间食管癌治疗和结局的变化。

Changes in treatment and outcome of oesophageal cancer in Denmark between 2004 and 2013.

机构信息

Department of Surgical Gastroenterology L, Aarhus University Hospital, Aarhus, Denmark.

Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.

出版信息

Br J Surg. 2017 Sep;104(10):1338-1345. doi: 10.1002/bjs.10586. Epub 2017 Jul 18.

DOI:10.1002/bjs.10586

PMID:28718940

Abstract

BACKGROUND

Since 2003, care for patients with oesophageal cancer has been centralized in a few dedicated centres in Denmark. The aim of this study was to assess changes in the treatment and outcome of patients registered in a nationwide database.

METHODS

All patients diagnosed with oesophageal cancer or cancer of the gastro-oesophageal junction who underwent oesophagectomy in Denmark between 2004 and 2013, and who were registered in the Danish clinical database of carcinomas in the oesophagus, gastro-oesophageal junction and stomach (DECV database) were included. Quality-of-care indicators, including number of lymph nodes removed, anastomotic leak rate, 30- and 90-day mortality, and 2- and 5-year overall survival, were assessed. To compare quality-of-care indicators over time, the relative risk (RR) was calculated using a multivariable log binomial regression model.

RESULTS

Some 6178 patients were included, of whom 1728 underwent oesophagectomy. The overall number of patients with 15 or more lymph nodes in the resection specimen increased from 38·1 per cent in 2004 to 88·7 per cent in 2013. The anastomotic leak rate decreased from 14·8 to 7·6 per cent (RR 0·66, 95 per cent c.i. 0·43 to 1·01). The 30-day mortality rate decreased from 4·5 to 1·7 per cent (RR 0·51, 0·22 to 1·15) and the 90-day mortality rate from 11·0 to 2·9 per cent (RR 0·46, 0·26 to 0·82). There were no statistically significant changes in 2- or 5-year survival rates over time.

CONCLUSION

Indicators of quality of care have improved since the centralization of oesophageal cancer treatment in Denmark.

摘要

背景

自 2003 年以来，丹麦的一些专门中心集中收治食管癌患者。本研究旨在评估登记在全国癌症数据库中的患者的治疗和预后变化。

方法

所有在丹麦接受食管癌或胃食管交界部癌手术的患者，以及在丹麦食管癌、胃食管交界部和胃的临床癌症数据库（DECV 数据库）中登记的患者，均被纳入研究。评估了包括切除淋巴结数量、吻合口漏率、30 天和 90 天死亡率以及 2 年和 5 年总生存率在内的质量指标。为了比较不同时期的质量指标，采用多变量对数二项式回归模型计算相对风险（RR）。

结果

共纳入 6178 例患者，其中 1728 例行食管癌切除术。标本中切除的淋巴结数达到 15 个或更多的患者比例从 2004 年的 38.1%增加到 2013 年的 88.7%。吻合口漏率从 14.8%下降至 7.6%（RR 0.66，95%置信区间 0.43 至 1.01）。30 天死亡率从 4.5%降至 1.7%（RR 0.51，0.22 至 1.15），90 天死亡率从 11.0%降至 2.9%（RR 0.46，0.26 至 0.82）。2 年和 5 年生存率在不同时期没有统计学上的显著变化。