Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France.
Gut. 2022 Aug;71(8):1532-1543. doi: 10.1136/gutjnl-2021-325266. Epub 2021 Nov 25.
To provide the first international comparison of oesophageal and gastric cancer survival by stage at diagnosis and histological subtype across high-income countries with similar access to healthcare.
As part of the ICBP SURVMARK-2 project, data from 28 923 patients with oesophageal cancer and 25 946 patients with gastric cancer diagnosed during 2012-2014 from 14 cancer registries in seven countries (Australia, Canada, Denmark, Ireland, New Zealand, Norway and the UK) were included. 1-year and 3-year age-standardised net survival were estimated by stage at diagnosis, histological subtype (oesophageal adenocarcinoma (OAC) and oesophageal squamous cell carcinoma (OSCC)) and country.
Oesophageal cancer survival was highest in Ireland and lowest in Canada at 1 (50.3% vs 41.3%, respectively) and 3 years (27.0% vs 19.2%) postdiagnosis. Survival from gastric cancer was highest in Australia and lowest in the UK, for both 1-year (55.2% vs 44.8%, respectively) and 3-year survival (33.7% vs 22.3%). Most patients with oesophageal and gastric cancer had regional or distant disease, with proportions ranging between 56% and 90% across countries. Stage-specific analyses showed that variation between countries was greatest for localised disease, where survival ranged between 66.6% in Australia and 83.2% in the UK for oesophageal cancer and between 75.5% in Australia and 94.3% in New Zealand for gastric cancer at 1-year postdiagnosis. While survival for OAC was generally higher than that for OSCC, disparities across countries were similar for both histological subtypes.
Survival from oesophageal and gastric cancer varies across high-income countries including within stage groups, particularly for localised disease. Disparities can partly be explained by earlier diagnosis resulting in more favourable stage distributions, and distributions of histological subtypes of oesophageal cancer across countries. Yet, differences in treatment, and also in cancer registration practice and the use of different staging methods and systems, across countries may have impacted the comparisons. While primary prevention remains key, advancements in early detection research are promising and will likely allow for additional risk stratification and survival improvements in the future.
通过在医疗保健可及性相似的高收入国家中，按诊断时的分期和组织学亚型，对食管癌和胃癌的生存情况进行首次国际比较。
作为国际癌症预后监测基准项目（ICBP SURVMARK-2）的一部分，纳入了来自澳大利亚、加拿大、丹麦、爱尔兰、新西兰、挪威和英国 7 个国家的 14 个癌症登记处，在 2012-2014 年期间诊断的 28923 例食管癌患者和 25946 例胃癌患者的数据。根据诊断时的分期、组织学亚型（食管腺癌（OAC）和食管鳞状细胞癌（OSCC））和国家，估计 1 年和 3 年的年龄标准化净生存率。
在诊断后 1 年（分别为 50.3% vs 41.3%）和 3 年（分别为 27.0% vs 19.2%），爱尔兰的食管癌生存率最高，加拿大最低。在澳大利亚，胃癌 1 年（分别为 55.2% vs 44.8%）和 3 年（分别为 33.7% vs 22.3%）的生存率最高，英国最低。大多数食管癌和胃癌患者为局部或远处疾病，各国的比例在 56%至 90%之间。分期特异性分析表明，局部疾病的国家间差异最大，在诊断后 1 年，澳大利亚的食管癌生存率为 66.6%，英国为 83.2%，而澳大利亚的胃癌生存率为 75.5%，新西兰为 94.3%。虽然 OAC 的生存率通常高于 OSCC，但这两种组织学亚型在各国之间的差异相似。
在包括分期组在内的高收入国家中，食管癌和胃癌的生存率存在差异，特别是在局部疾病方面。这种差异部分可以用更有利的分期分布来解释，也可以用不同国家间的食管癌组织学亚型分布来解释。然而，各国之间的治疗差异，以及癌症登记实践的差异，以及不同分期方法和系统的使用，也可能影响了这些比较。虽然初级预防仍然是关键，但早期检测研究的进展令人鼓舞，这可能会在未来允许进行额外的风险分层和生存改善。
