Kuijper Steven C, Pape Marieke, Vissers Pauline A J, Jeene Paul M, Kouwenhoven Ewout A, Haj Mohammad Nadia, Ruurda Jelle P, Sosef Meindert N, Verhoeven Rob H A, van Laarhoven Hanneke W M
Amsterdam UMC location University of Amsterdam, Medical Oncology, Amsterdam, The Netherlands.
Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, The Netherlands.
Int J Cancer. 2023 Jul 1;153(1):33-43. doi: 10.1002/ijc.34488. Epub 2023 Mar 24.
New treatment options and centralization of surgery have improved survival for patients with non-metastatic esophageal or gastric cancer. It is unknown, however, which patients benefitted the most from treatment advances. The aim of this study was to identify best-case, typical and worst-case scenarios in terms of survival time, and to assess if survival associated with these scenarios changed over time. Patients with non-metastatic potentially resectable esophageal or gastric cancer diagnosed between 2006 and 2020 were selected from the Netherlands Cancer Registry. Best-case (20th percentile), upper-typical (40th percentile), typical (median), lower-typical (60th percentile) and worst-case (80th percentile) survival scenarios were defined, and regression analysis was used to investigate the change in survival time for each scenario across years. For patients with esophageal cancer (N = 24 352) survival time improved on average 12.0 (until 2011), 1.5 (until 2018), 0.7, 0.4 and 0.2 months per year for the best-case, upper-typical, median, lower-typical and worst-case scenario, respectively. For patients with gastric cancer (N = 9993) survival time of the best-case scenario remained constant, whereas the upper-typical, median, lower-typical and worst-case scenario improved on average with 1.0 (until 2018), 0.5, 0.2 and 0.2 months per year, respectively. Subgroup analyses showed that, survival scenarios improved for nearly all patients across treatment groups and for patients with squamous cell carcinomas or adenocarcinomas. Survival improved for almost all patients suggesting that in clinical practice the vast majority of patients benefitted from treatment advances. The clinically most meaningful survival advantage was observed for the best-case scenario of esophageal cancer.
新的治疗方案和手术的集中化改善了非转移性食管癌或胃癌患者的生存率。然而，尚不清楚哪些患者从治疗进展中获益最大。本研究的目的是确定生存时间方面的最佳、典型和最差情况，并评估与这些情况相关的生存情况是否随时间变化。从荷兰癌症登记处选取了2006年至2020年间诊断为非转移性潜在可切除食管癌或胃癌的患者。定义了最佳情况（第20百分位数）、上典型情况（第40百分位数）、典型情况（中位数）、下典型情况（第60百分位数）和最差情况（第80百分位数）的生存情况，并使用回归分析来研究各情况的生存时间随年份的变化。对于食管癌患者（N = 24352），最佳、上典型、中位数、下典型和最差情况的生存时间每年平均分别改善12.0个月（至2011年）、1.5个月（至2018年）、0.7个月、0.4个月和0.2个月。对于胃癌患者（N = 9993），最佳情况的生存时间保持不变，而上典型、中位数、下典型和最差情况每年平均分别改善1.0个月（至2018年）、0.5个月、0.2个月和0.2个月。亚组分析表明，几乎所有治疗组的患者以及鳞状细胞癌或腺癌患者的生存情况均有所改善。几乎所有患者的生存率都有所提高，这表明在临床实践中，绝大多数患者都从治疗进展中获益。食管癌的最佳情况观察到临床上最有意义的生存优势。
