Tang Dehua, Ni Muhan, Zhu Hao, Cao Jun, Zhou Lin, Shen Shanshan, Peng Chunyan, Lv Ying, Xu Guifang, Wang Lei, Zou Xiaoping
Department of Gastroenterology, Nanjing Drum Tower Hospital, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China.
Ann Transl Med. 2021 Apr;9(8):646. doi: 10.21037/atm-20-7953.
Our study aims to analyze the association between Lauren's classification and gastric adenocarcinoma prognosis using comprehensive statistical analyses.
According to the selection criteria, patients were included from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate Cox regression, propensity score matching, and a multivariate competing risk model were used to investigate the association between Lauren's classification and prognosis. Subgroup analysis was used to investigate the role of confounding factors on the association between Lauren types and prognosis.
After exclusion, a total of 20,218 patients from the SEER database were included, with 14,374 intestinal types and 5,844 diffuse types. The univariate Cox regression analysis revealed that the diffuse type had a poorer cancer-specific survival (CSS) rate [hazard ratio (HR), 1.44; 95% confidence interval (CI), 1.38-1.50]. After adjusting for confounding variables, the diffuse type also showed a higher risk of cancer-specific death (HR, 1.20; 95% CI, 1.15-1.20). Sensitivity analysis showed that after propensity score matching, the diffuse type had a poorer CSS rate (HR, 1.23; 95% CI, 1.10-1.36), and the competing risk model further validated these results [subdistribution HR (SHR), 1.32; 95% CI, 1.23-1.41]. Moreover, subgroup analysis demonstrated stable results in the subgroups, except for patients with T1 stage (HR, 1.06; 95% CI, 0.87-1.28) and a tumor size <2 cm (HR, 1.00; 95% CI, 0.83-1.21).
Diffuse-type gastric adenocarcinoma had an overall poorer prognosis compared to the intestinal type. However, in patients with T1 stage and tumor size <2 cm, the diffuse type had a comparable survival rate with the intestinal type.
我们的研究旨在通过全面的统计分析来分析劳伦分类与胃腺癌预后之间的关联。
根据入选标准，从监测、流行病学和最终结果（SEER）数据库中纳入患者。采用单因素和多因素Cox回归、倾向评分匹配和多因素竞争风险模型来研究劳伦分类与预后之间的关联。亚组分析用于研究混杂因素对劳伦类型与预后之间关联的作用。
排除后，共纳入了SEER数据库中的20218例患者，其中肠型14374例，弥漫型5844例。单因素Cox回归分析显示，弥漫型的癌症特异性生存率（CSS）较差[风险比（HR），1.44；95%置信区间（CI），1.38 - 1.50]。在调整混杂变量后，弥漫型也显示出更高的癌症特异性死亡风险（HR，1.20；95% CI，1.15 - 1.20）。敏感性分析表明，倾向评分匹配后，弥漫型的CSS较差（HR，1.23；95% CI，1.10 - 1.36），竞争风险模型进一步验证了这些结果[亚分布风险比（SHR），1.32；95% CI，1.23 - 1.41]。此外，亚组分析表明，除T1期患者（HR，1.06；95% CI，0.87 - 1.28）和肿瘤大小<2 cm的患者（HR，1.00；95% CI，0.83 - 1.21）外，各亚组结果稳定。
与肠型相比，弥漫型胃腺癌的总体预后较差。然而，在T1期且肿瘤大小<2 cm的患者中，弥漫型与肠型的生存率相当。
