Department of Molecular Medicine and Surgery, Upper Gastrointestinal Surgery, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
School of Cancer and Pharmaceutical Sciences, King's College London, London, UK.
Acta Oncol. 2021 Apr;60(4):513-520. doi: 10.1080/0284186X.2021.1874619. Epub 2021 Jan 27.
Most studies examining prognostic factors after gastrectomy come from selected patients and non-Western populations. This nationwide population-based cohort study aims to identify prognostic factors after surgery for gastric adenocarcinoma in an unselected Western cohort.
This study included 98% of patients who underwent gastrectomy for gastric adenocarcinoma in Sweden in 2006-2015, with follow-up through 2019. Data were collected from medical records and national registries. Exposures were sex, age, education, comorbidity, tumor sub-localization, tumor stage, calendar period, and pre-operative chemotherapy. Outcomes were 3-year all-cause and disease-specific mortality. Cox regression produced hazard ratios (HRs) with 95% confidence intervals (95% CIs), adjusted for the other study exposures.
Among all 2154 patients, 3-year all-cause mortality was 53.3%. Factors influencing 3-year all-cause mortality after multivariable adjustment were tumor stage (stage IV vs. stage 0-I: HR 8.72, 95% CI 6.77-11.24), comorbidity (Charlson comorbidity score ≥2 vs. 0: HR 1.63, 95% CI 1.39-1.90), age (>75 vs. <65 years: HR 1.48, 95% CI 1.24-1.78), and calendar period (2006-2010 vs. 2011-2015: HR 0.83, 95% CI 0.73-0.95). No independent prognostic influence was found for sex (women vs. men: HR 1.01, 95% CI 0.85-1.09), pre-operative chemotherapy (yes vs. no: HR 0.92, 95% CI 0.78-1.08), tumor sub-localization (non-cardia vs. cardia: HR 1.01, 95% CI 0.83-1.22), or education (≥13 vs. ≤9 years: HR 0.89, 95% CI 0.74-1.07). The results were similar for 3-year disease-specific mortality.
Survival after gastrectomy for gastric adenocarcinoma needs further improvement. Tumor stage, comorbidity, age, and calendar period were independently prognostic, while sex, pre-operative chemotherapy, tumor sub-localization, and education were not.
大多数研究胃癌手术后预后因素的研究都来自于特定的患者和非西方人群。本项全国范围内基于人群的队列研究旨在确定在未经选择的西方人群中，胃腺癌手术后的预后因素。
本研究纳入了 2006 年至 2015 年期间在瑞典接受胃腺癌手术的 98%患者，随访至 2019 年。数据来自病历和国家登记处。暴露因素包括性别、年龄、教育程度、合并症、肿瘤局部定位、肿瘤分期、日历时间和术前化疗。结局为 3 年全因和疾病特异性死亡率。Cox 回归得出了风险比（HR）及其 95%置信区间（95%CI），并对其他研究暴露因素进行了调整。
在所有 2154 例患者中，3 年全因死亡率为 53.3%。多变量调整后影响 3 年全因死亡率的因素包括肿瘤分期（IV 期与 0-1 期：HR 8.72，95%CI 6.77-11.24）、合并症（Charlson 合并症评分≥2 与 0：HR 1.63，95%CI 1.39-1.90）、年龄（>75 岁与<65 岁：HR 1.48，95%CI 1.24-1.78）和日历时间（2006-2010 年与 2011-2015 年：HR 0.83，95%CI 0.73-0.95）。未发现性别（女性与男性：HR 1.01，95%CI 0.85-1.09）、术前化疗（是与否：HR 0.92，95%CI 0.78-1.08）、肿瘤局部定位（非贲门与贲门：HR 1.01，95%CI 0.83-1.22）或教育程度（≥13 年与≤9 年：HR 0.89，95%CI 0.74-1.07）对预后有独立影响。3 年疾病特异性死亡率的结果相似。
胃腺癌手术后的生存需要进一步改善。肿瘤分期、合并症、年龄和日历时间是独立的预后因素，而性别、术前化疗、肿瘤局部定位和教育程度不是。
