Paknazar Fatemeh, Mahmoudi Mahmood, Mohammad Kazem, Zeraati Hojjat, Mansournia Mohammad Ali, Yaseri Mahdi
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Iran J Med Sci. 2018 Nov;43(6):605-611.
Iran is an Eastern Mediterranean region country with the highest rate of gastric cancer. The present study aimed to evaluate the 5-year net survival of patients with gastric cancer in Iran using a relative survival framework.
In a cross-sectional study, using life-table estimation of relative survival, we reported 1- to 5-year relative survival regarding age, sex, disease stage, pathology, and adjuvant therapies via modeling excess mortality. All the analyses were done applying Stata 11.2 with a confidence level of 95%.
Data on 330 patients (aged 32-96 y), who were comprised of 228 (69.1%) men and 102 (30.1%) women with gastric cancer and were followed up for 10 years, were analyzed. Adenocarcinoma was the most common malignancy (281 [85.2%] patients), and 248 (75.1%) patients were at stage 3 or stage 4. The 1- and 5-year net survival rates after surgery were 67.96 (95% CI: 62.35-72.98) and 23.35 (95% CI: 17.94-29.28), respectively. Higher stages (P=0.001), older ages (P=0.007), and less use of adjuvant therapies (P<0.001) were independently associated with excess mortality.
It is recommended to use the relative survival framework to analyze the survival of cancer patients as an alternative approach not only to eliminate biases due to competing risks and their dependencies but also to estimate the cure at the population level concerning the most important individual characteristics. Our findings showed that the survival rate of gastric cancer in Iran is lower than that in most developed countries in terms of net survival.
伊朗是东地中海地区胃癌发病率最高的国家。本研究旨在使用相对生存框架评估伊朗胃癌患者的5年净生存率。
在一项横断面研究中，我们通过对超额死亡率进行建模，采用相对生存的生命表估计法，报告了1至5年的相对生存率，涉及年龄、性别、疾病分期、病理和辅助治疗情况。所有分析均使用Stata 11.2软件完成，置信水平为95%。
分析了330例患者（年龄32 - 96岁）的数据，其中包括228例（69.1%）男性和102例（30.1%）女性胃癌患者，随访时间为10年。腺癌是最常见的恶性肿瘤（281例[85.2%]患者），248例（75.1%）患者处于3期或4期。手术后1年和5年的净生存率分别为67.96（95%CI：62.35 - 72.98）和23.35（95%CI：17.94 - 29.28）。更高的分期（P = 0.001）、更年长的年龄（P = 0.007）以及辅助治疗使用较少（P < 0.001）与超额死亡率独立相关。
建议使用相对生存框架来分析癌症患者的生存情况，作为一种替代方法，不仅可以消除由于竞争风险及其依赖性导致的偏差，还可以在人群水平上估计与最重要个体特征相关的治愈情况。我们的研究结果表明，就净生存率而言，伊朗胃癌患者的生存率低于大多数发达国家。
