Griffin F, Hunter R, McCouaig P, Murchie P, Nanthakumaran S, Ramsay G
Department of General Surgery, Aberdeen Royal Infirmary, United Kingdom.
Centre of Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, United Kingdom.
Surgeon. 2023 Jun;21(3):e97-e103. doi: 10.1016/j.surge.2022.04.011. Epub 2022 May 21.
Despite advances in oncology therapies and surgical techniques, survival from oesophagogastric cancer remains low. Poorer cancer outcomes and survival for rural dwellers is documented worldwide and has been an area of focus in Scotland since 2007 when changes to suspected cancer national referral guidelines and governmental mandates on delivering remote and rural healthcare occurred. Whether these changes in clinical practice has impacted upon upper gastrointestinal cancer remains unclear.
A prospective, single-centre observation study was performed. Data from the regional oesophagogastric cancer MDT between 2013 and 2019 were included. The Scottish Index of Multiple Deprivation 2020 tool provided a rurality code (1 or 2) based on patient postcode at time of referral. Survival outcomes for urban and rural patients were compared across demographic factors, disease factors and stage at presentation.
A total of 1038 patients were included in this study. There was no significant difference between rural and urban groups in terms of sex of patient, age at diagnosis, cancer location, or tumour stage. Furthermore, no difference was identified between those commenced on a radical therapy with other treatment plans. Despite this, rurality predicted for an improved outcome on survival analysis (p = 0.012) and this was independent of other factors on multivariable analysis (HR = 0.78, 95%CI 0.66-0.98; p = 0.032).
The difference in survival demonstrated here between urban and rural groups is not easily explained but may represent improvements to rural access to healthcare delivered as a result of Scottish Government reports.
尽管肿瘤治疗和手术技术取得了进展，但食管癌和胃癌患者的生存率仍然很低。全球范围内都有文献记载农村居民的癌症治疗效果和生存率较差，自2007年疑似癌症国家转诊指南发生变化以及政府发布关于提供偏远和农村地区医疗保健的指令以来，这一直是苏格兰关注的一个领域。临床实践中的这些变化是否对上消化道癌症产生了影响尚不清楚。
进行了一项前瞻性单中心观察性研究。纳入了2013年至2019年期间区域食管癌和胃癌多学科诊疗团队（MDT）的数据。2020年苏格兰多重贫困指数工具根据患者转诊时的邮政编码提供了一个农村代码（1或2）。比较了城乡患者在人口统计学因素、疾病因素和就诊时分期方面的生存结果。
本研究共纳入1038例患者。农村和城市组在患者性别、诊断年龄、癌症位置或肿瘤分期方面没有显著差异。此外，开始接受根治性治疗与其他治疗方案的患者之间也没有差异。尽管如此，在生存分析中，农村地区预示着更好的结果（p = 0.012），并且在多变量分析中这与其他因素无关（风险比 = 0.78，95%置信区间0.66 - 0.98；p = 0.032）。
这里显示的城乡组生存差异难以轻易解释，但可能代表了由于苏格兰政府的报告，农村地区获得医疗保健的情况有所改善。
