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超越中位总生存期:评估转移性胃食管交界癌患者多种生存情况的趋势。

Beyond Median Overall Survival: Estimating Trends for Multiple Survival Scenarios in Patients With Metastatic Esophagogastric Cancer.

机构信息

1Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht.

2Department of Medical Oncology, University of Amsterdam, Amsterdam.

出版信息

J Natl Compr Canc Netw. 2022 Dec;20(12):1321-1329.e4. doi: 10.6004/jnccn.2022.7066.

Abstract

BACKGROUND

In recent years, clinical trials have shown improved survival of patients with metastatic esophageal or gastric cancer. The number of patients participating in clinical trials is limited, and survival improvements observed from clinical trials are unrepresentative for the full population. The aim of our study was to assess trends in survival for the best-case, typical, and worst-case scenarios in patients with metastatic esophageal or gastric cancer.

METHODS

We selected patients with metastatic esophageal or gastric cancer diagnosed between 2006 and 2020 from the nationwide Netherlands Cancer Registry. Survival was calculated for different percentiles of the survival curve for each incidence year (eg, the 10th percentile [p10] represents the top 10% of patients with the best survival): p10 (best-case), p25 (upper-typical), p50 (median), p75 (lower-typical), and p90 (worst-case). Weighted linear regression analyses were performed to test whether changes in survival were significant.

RESULTS

The overall median survival between 2006 and 2020 remained unchanged for patients with esophageal cancer (n=10,448; from 5.2 to 5.2 months, respectively; P=.06) and improved for patients with gastric cancer (n=10,512; from 3.5 to 4.3 months, respectively; P=.001). For patients with esophageal cancer, survival for the best-case scenario (p10; best 10% of patients) significantly improved from 17.2 to 21.0 months (P=.006). For patients with gastric cancer, survival significantly improved for the best-case scenario (p10) from 15.9 to 23.5 months (P<.001) and the upper-typical scenario (p25) scenario improved from 7.9 to 9.9 months (P<.001).

CONCLUSIONS

Despite significant survival improvements in clinical trials, survival improvements were not observed for the majority of patients treated in daily clinical practice. An increase in survival was only observed for patients with the best prognosis.

摘要

背景

近年来,临床试验显示转移性食管或胃腺癌患者的生存率提高。参与临床试验的患者数量有限,临床试验中观察到的生存改善并不能代表所有人群。我们的研究旨在评估转移性食管或胃腺癌患者最佳、典型和最差情况下的生存趋势。

方法

我们从全国性的荷兰癌症登记处中选择了 2006 年至 2020 年间诊断为转移性食管或胃腺癌的患者。根据每个发病年份的生存曲线的不同百分位数(例如,第 10 个百分位数 [p10] 代表生存最佳的前 10%的患者)计算生存情况:p10(最佳情况)、p25(上典型)、p50(中位数)、p75(下典型)和 p90(最差情况)。进行加权线性回归分析以检验生存变化是否具有统计学意义。

结果

2006 年至 2020 年间,食管腺癌患者的总体中位生存期无变化(n=10448;分别为 5.2 和 5.2 个月,P=.06),胃腺癌患者的生存期有所改善(n=10512;分别为 3.5 和 4.3 个月,P=.001)。对于食管腺癌患者,最佳情况(p10;最佳的 10%的患者)的生存情况从 17.2 个月显著改善至 21.0 个月(P=.006)。对于胃腺癌患者,最佳情况(p10)的生存情况从 15.9 个月显著改善至 23.5 个月(P<.001),上典型情况(p25)的生存情况从 7.9 个月显著改善至 9.9 个月(P<.001)。

结论

尽管临床试验中观察到生存率显著提高,但在大多数在日常临床实践中接受治疗的患者中并未观察到生存改善。只有预后最佳的患者的生存率才有所增加。

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