Minhas Ahmed A, Fatima Zainab, Kommineni Sai Karthik, Ahmad Zaid, Minhas Sohail A
Internal Medicine, East Tennessee State University Quillen College of Medicine, Johnson City, USA.
Medicine, Meharry Medical College, Nashville, USA.
Cureus. 2021 Oct 7;13(10):e18571. doi: 10.7759/cureus.18571. eCollection 2021 Oct.
Background Gastric cancer is one of the most prevalent cancers in the world and the third most common cause of death from cancer. The diagnosis and treatment are often complex and require a multifaceted approach. Hence, appropriate and timely management is essential for better patient outcomes. Our aim was to determine if rural inhabitation affects the mortality of patients with gastric adenocarcinoma. If such an association exists, we propose to ascertain whether this is related to delayed diagnosis, differing tumor characteristics, or treatment inequalities. Methods The Cox model was applied to gastric adenocarcinoma cases diagnosed during 2004-2011 in American residents aged 20+ years in the Surveillance, Epidemiology, and End Results (SEER) program to determine the impact of rurality on mortality. Binary logistic regression was used to compare the odds of not receiving surgical treatment for localized tumors between rural and urban areas. It was also used to measure the association of rurality with stage at diagnosis (non-metastatic vs. metastatic). Results There was a significant association of rurality on 5-year mortality [HR 1.14 (1.09-1.20), p < 0.01]. No significant association was observed between rural-urban residency and stage at diagnosis, with an odds ratio (OR) of 0.95 (0.87-1.03), p = 0.21. The median time from diagnosis to any first-course treatment was one month for both rural and urban counties. Rural residents were far more likely not to receive surgical treatment for localized tumors than their urban counterparts [OR 1.70 (1.41-2.05), p < 0.01]. A greater percentage of rural inhabitants had cardia tumors as compared to urban ones, 39.8% vs. 33.8% respectively. Non-cardia tumors were far less likely not to receive surgical treatment (i.e., more likely to receive surgical treatment) than cardia tumors [OR 0.35 (0.30-0.41), p < 0.01]. Conclusions Rurality is associated with worse gastric adenocarcinoma mortality. This may be due to a lesser probability of receiving surgical treatment for early-stage disease and differences in the primary site of the tumor between rural and urban counties, but not due to differences in stage at presentation. Future research should focus on improving health care access in rural communities.
胃癌是世界上最常见的癌症之一，也是癌症死亡的第三大常见原因。其诊断和治疗通常很复杂，需要多方面的方法。因此，适当及时的管理对于改善患者预后至关重要。我们的目的是确定农村居住环境是否会影响胃腺癌患者的死亡率。如果存在这种关联，我们建议确定这是否与诊断延迟、肿瘤特征不同或治疗不平等有关。
将Cox模型应用于2004年至2011年在美国监测、流行病学和最终结果（SEER）项目中诊断出的20岁及以上胃腺癌病例，以确定农村环境对死亡率的影响。二元逻辑回归用于比较农村和城市地区局部肿瘤未接受手术治疗的几率。它还用于衡量农村环境与诊断阶段（非转移性与转移性）之间的关联。
农村环境与5年死亡率存在显著关联[风险比1.14（1.09 - 1.20），p < 0.01]。农村和城市居住与诊断阶段之间未观察到显著关联，优势比（OR）为0.95（0.87 - 1.03），p = 0.21。农村和城市县从诊断到任何首次治疗的中位时间均为1个月。农村居民局部肿瘤未接受手术治疗的可能性远高于城市居民[OR 1.70（1.41 - 2.05），p < 0.01]。与城市居民相比，农村居民患贲门肿瘤的比例更高，分别为39.8%和33.8%。非贲门肿瘤未接受手术治疗的可能性（即更有可能接受手术治疗）远低于贲门肿瘤[OR 0.35（0.30 - 0.41），p < 0.01]。
农村环境与胃腺癌死亡率较高有关。这可能是由于早期疾病接受手术治疗的可能性较小以及农村和城市县肿瘤原发部位的差异，但不是由于就诊时的阶段差异。未来的研究应侧重于改善农村社区的医疗保健可及性。
