Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, 10408, Korea.
National Cancer Control Institute, National Cancer Center, Goyang, 10408, Korea.
J Gastroenterol. 2022 Jul;57(7):464-475. doi: 10.1007/s00535-022-01878-4. Epub 2022 May 14.
Gastric cancer (GC) is the most common cancer type in Korea. Korean National Cancer Screening Program (KNCSP) offer either upper gastrointestinal series (UGIS) or upper endoscopy biennially for adults aged ≥ 40. This study aimed to investigate the effect of cancer screening program on the long-term survival among GC patients.
A nationwide population-based cohort was constructed based on three national databases. Overall, 46,701 GC patients diagnosed in 2008 and 2009 were included in our final analysis, and they were followed-up until the end of 2019. Survival curves were estimated using the Kaplan-Meier analysis with the log-rank test. Cox proportional-hazards regression analysis was used to report the hazard ratios (HRs) with 95% confidence intervals.
A total of 18,614/46,701 (39.9%) patients died during the median follow-up time of 10.5 years. The survival rate was higher among screened patients (65.8%) than never-screened patients (49.1%). Screened patients had 53% (HR, 0.47; 95% CI 0.45-0.48) lower risk of death from GC. The HRs of GC-specific mortality was lower in upper endoscopy group (HR = 0.36; 95% CI = 0.34-0.37) compared with UGIS (HR = 0.69; 95% CI = 0.67-0.73). Screened patients within 2 years prior to cancer diagnosis had a 35% reduction in risk of GC death. The figure decline to approximately 19% among patients with interval time since last screening of > 3 years.
Our findings emphasized the positive effects of GC screening on long-term GC patient survival. Also, patients screened by upper endoscopy or within 2 years before diagnosis had the best survival outcomes.
胃癌（GC）是韩国最常见的癌症类型。韩国国家癌症筛查计划（KNCSP）为 40 岁及以上的成年人每两年提供上消化道系列（UGIS）或内窥镜检查。本研究旨在调查癌症筛查计划对 GC 患者长期生存的影响。
基于三个国家数据库构建了一项全国性的基于人群的队列。共有 46701 例 2008 年和 2009 年诊断的 GC 患者纳入最终分析，并随访至 2019 年底。使用 Kaplan-Meier 分析和对数秩检验估计生存曲线。使用 Cox 比例风险回归分析报告危险比（HR）及其 95%置信区间。
在中位随访 10.5 年期间，共有 18614/46701（39.9%）名患者死亡。筛查患者（65.8%）的生存率高于未筛查患者（49.1%）。筛查患者死于 GC 的风险降低了 53%（HR，0.47；95%CI，0.45-0.48）。与 UGIS 相比，内窥镜组（HR=0.36；95%CI=0.34-0.37）的 GC 特异性死亡率 HR 较低。诊断前 2 年内接受筛查的患者 GC 死亡风险降低了 35%。对于上次筛查后间隔时间>3 年的患者，这一数字下降到约 19%。
我们的研究结果强调了 GC 筛查对长期 GC 患者生存的积极影响。此外，通过内窥镜或诊断前 2 年内接受筛查的患者具有最佳的生存结果。
