Liu Guihua, Xu Ming, Gao Tingting, Xu Lingying, Zeng Peijun, Bo Haiying, Li Fang, Zhang Wei, Wang Zhengting
Department of General Practice, Zhongshan Street Community Health Center of Songjiang District, Shanghai, 201600, China.
Department of General Surgery, Tongren Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200001, China.
J Cancer. 2019 Feb 2;10(4):779-788. doi: 10.7150/jca.29073. eCollection 2019.
Surgical resection is one of curative treatment for gastric cancer (GC), however, a set of patients show poor surgical compliance in the USA. We aimed to identify the risk factors associated with surgical compliance and investigate the difference in survival. GC patients diagnosed between 1973 and 2014 were identified from the Surveillance Epidemiology and End Results (SEER) databases. Based on different surgical compliance and treatment regimen, patients were classified into three subgroups: surgical compliance group, surgical noncompliance group, and non-surgical group. Multivariable Logistic regression analysis was adopted to identify the factors related to surgical compliance; Multivariable Cox regression was used to investigate the prognostic factors. Overall survival (OS) and cancer-specific survival (CSS) were analyzed using the Kaplan-Meier estimator method. Of 79374 GC patients who were recommended for surgical therapy, 15201(19.2%) cases did not perform surgery. Poor compliance of surgery was related to old age, American Indian/Alaska Native race, poor grading/late staging, single/widowed status, lower socioeconomic status and earlier time of diagnosis. As expected, GC patients of surgical compliance group showed significantly more favorable survival than the other two groups (P<0.0001); notably, the outcome of surgical noncompliance group came close to that of non-surgical group. GC patients of poor surgical compliance demonstrated adverse survival, which was comparable to that of non-surgical patients. The poor surgical compliance was associated with older age, American Indian/Alaska Native race, poor tissue differentiation/advanced stage of tumor, single/widowed status, lower socioeconomic status and earlier time of diagnosis.
手术切除是胃癌（GC）的一种根治性治疗方法，然而，在美国有一部分患者手术依从性较差。我们旨在确定与手术依从性相关的风险因素，并研究生存差异。从监测、流行病学和最终结果（SEER）数据库中识别出1973年至2014年期间诊断的GC患者。根据不同的手术依从性和治疗方案，患者被分为三个亚组：手术依从组、手术不依从组和非手术组。采用多变量逻辑回归分析来确定与手术依从性相关的因素；多变量Cox回归用于研究预后因素。使用Kaplan-Meier估计方法分析总生存期（OS）和癌症特异性生存期（CSS）。在79374例被推荐进行手术治疗的GC患者中，15201例（19.2%）未进行手术。手术依从性差与老年、美国印第安人/阿拉斯加原住民种族、分级差/分期晚、单身/丧偶状态、社会经济地位较低以及诊断时间较早有关。正如预期的那样，手术依从组的GC患者生存率明显高于其他两组（P<0.0001）；值得注意的是，手术不依从组的结果接近非手术组。手术依从性差的GC患者生存情况不佳，与非手术患者相当。手术依从性差与老年、美国印第安人/阿拉斯加原住民种族、组织分化差/肿瘤晚期、单身/丧偶状态、社会经济地位较低以及诊断时间较早有关。
