Department of Internal Medicine, Division of Medical Oncology, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, 6202 AZ, the Netherlands.
Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Eindhoven, 5612 HZ, the Netherlands.
Eur J Surg Oncol. 2021 Jul;47(7):1742-1749. doi: 10.1016/j.ejso.2021.02.028. Epub 2021 Mar 6.
Ampullary cancer is rare and as a result epidemiological data are scarce. The aim of this population-based study was to determine the trends in incidence, treatment and overall survival (OS) in patients with ampullary adenocarcinoma in the Netherlands between 1989 and 2016.
Patients diagnosed with ampullary adenocarcinoma were identified from the Netherlands Cancer Registry. Incidence rates were age-adjusted to the European standard population. Trends in treatment and OS were studied over (7 years) period of diagnosis, using Kaplan-Meier and Cox regression analyses for OS and stratified by the presence of metastatic disease.
In total, 3840 patients with ampullary adenocarcinoma were diagnosed of whom, 55.0% were male and 87.1% had non-metastatic disease. The incidence increased from 0.59 per 100,000 in 1989-1995 to 0.68 per 100,000in 2010-2016. In non-metastatic disease, the resection rate increased from 49.5% in 1989-1995 to 63.9% in 2010-2016 (p < 0.001). The rate of adjuvant therapy increased from 3.1% to 7.9%. In non-metastatic disease, five-year OS (95% CI) increased from 19.8% (16.9-22.8) in 1989-1995 to 29.1% (26.0-31.2) in 2010-2016 (logrank p < 0.001). In patients with metastatic disease, median OS did not significantly improve (from 4.4 months (3.6-5.0) to 5.9 months (4.7-7.1); logrank p = 0.06). Cancer treatment was an independent prognostic factor for OS among all patients.
Both incidence and OS of ampullary cancer increased from 1989 to 2016 which is most likely related to the observed increased resection rates and use of adjuvant therapy.
壶腹癌较为罕见，因此流行病学数据较为匮乏。本项基于人群的研究旨在明确 1989 年至 2016 年间荷兰壶腹腺癌患者的发病率、治疗方法和总体生存（OS）趋势。
从荷兰癌症登记处获取诊断为壶腹腺癌的患者。通过年龄调整至欧洲标准人口，计算发病率。使用 Kaplan-Meier 和 Cox 回归分析研究 OS 以及按转移性疾病的存在情况分层的 7 年诊断期间的治疗方法和 OS 趋势。
共诊断出 3840 例壶腹腺癌患者，其中 55.0%为男性，87.1%为非转移性疾病。发病率从 1989-1995 年的 0.59/100000 增加至 2010-2016 年的 0.68/100000。在非转移性疾病中，手术切除率从 1989-1995 年的 49.5%增加至 2010-2016 年的 63.9%（p<0.001）。辅助治疗率从 3.1%增加至 7.9%。在非转移性疾病中，五年 OS（95%CI）从 1989-1995 年的 19.8%（16.9-22.8）增加至 2010-2016 年的 29.1%（26.0-31.2）（对数秩检验 p<0.001）。转移性疾病患者的中位 OS 无显著改善（从 4.4 个月（3.6-5.0）增加至 5.9 个月（4.7-7.1）；对数秩检验 p=0.06）。癌症治疗是所有患者 OS 的独立预后因素。
1989 年至 2016 年间，壶腹癌的发病率和 OS 均有所增加，这很可能与观察到的手术切除率增加和辅助治疗的应用有关。
