Kung C-H, Jestin Hannan C, Linder G, Johansson J, Nilsson M, Hedberg J, Lindblad M
Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
Department of Surgery, Skellefteå County Hospital, Skellefteå, Sweden.
BJS Open. 2021 Mar 5;5(2). doi: 10.1093/bjsopen/zraa017.
There are marked geographical variations in the proportion of patients undergoing resection for gastric cancer. This study investigated the impact of resection rate on survival.
All patients with potentially curable gastric cancer between 2006 and 2017 were identified from the Swedish National Register of Oesophageal and Gastric Cancer. The annual resection rate was calculated for each county per year. Resection rates in all counties for all years were grouped into tertiles and classified as low, intermediate or high. Survival was analysed using the Cox proportional hazards model.
A total of 3465 patients were diagnosed with potentially curable gastric cancer, and 1934 (55.8 per cent) were resected. Resection rates in the low (1261 patients), intermediate (1141) and high (1063) tertiles were 0-50.0, 50.1-62.5 and 62.6-100 per cent respectively. The multivariable Cox analysis revealed better survival for patients diagnosed in counties during years with an intermediate versus low resection rate (hazard ratio (HR) 0.81, 95 per cent c.i. 0.74 to 0.90; P < 0.001) and high versus low resection rate (HR 0.80, 0.73 to 0.88; P < 0.001).
This national register study showed large regional variation in resection rates for gastric cancer. A higher resection rate appeared to be beneficial with regard to overall survival for the entire population.
接受胃癌切除术的患者比例存在显著的地域差异。本研究调查了切除率对生存的影响。
从瑞典国家食管癌和胃癌登记处识别出2006年至2017年间所有可能治愈的胃癌患者。计算每年每个县的年切除率。将所有年份所有县的切除率分为三分位数，并分为低、中、高三类。使用Cox比例风险模型分析生存情况。
共有3465例患者被诊断为可能治愈的胃癌，其中1934例（55.8%）接受了手术切除。低三分位数组（1261例患者）、中三分位数组（1141例）和高三分位数组（1063例）的切除率分别为0 - 50.0%、50.1 - 62.5%和62.6 - 100%。多变量Cox分析显示，与低切除率年份相比，中切除率年份诊断的患者生存情况更好（风险比（HR）0.81，95%置信区间0.74至0.90；P < 0.001），高切除率年份与低切除率年份相比也是如此（HR 0.80，0.73至0.88；P < 0.001）。
这项全国登记研究表明，胃癌切除率存在很大的地区差异。较高的切除率似乎对整个人口的总体生存有益。
