Department of Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK.
School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK.
Br J Surg. 2023 May 16;110(6):701-709. doi: 10.1093/bjs/znad065.
The National Oesophago-Gastric Cancer Audit (NOGCA) captures patient data from diagnosis to end of primary treatment for all patients with oesophagogastric (OG) cancer in England and Wales. This study assessed changes in patient characteristics, treatments received, and outcomes for OG cancer surgery for the period 2012-2020, and examined which factors may have led to changes in clinical outcomes over this time.
Patients diagnosed with OG cancer between April 2012 and March 2020 were included. Descriptive statistics were used to summarize patient demographics, disease site, type, and stage, patterns of care, and outcomes over time. The treatment variables of unit case volume, surgical approach, and neoadjuvant therapy were included. Regression models were used to examine associations between surgical outcomes (duration of stay and mortality), and patient and treatment variables.
In total, 83 393 patients diagnosed with OG cancer during the study period were included. Patient demographics and cancer stage at diagnosis showed little change over time. Altogether, 17 650 patients underwent surgery as part of radical treatment. These patients had increasingly more advanced cancers, and a greater likelihood of pre-existing comorbidity in more recent years. Significant decreases in mortality rates and duration of stay were noted, along with improvements in oncological outcomes (nodal yields and margin positivity rates). Following adjustment for patient and treatment variables, increasing audit year and trust volume were associated, respectively, with improved postoperative outcomes: lower 30-day mortality (odds ratio (OR) 0.93 (95 per cent c.i. 0.88 to 0.98) and OR 0.99 (95 per cent c.i. 0.99-0.99)) and lower 90-day mortality (OR 0.94 (95 per cent c.i. 0.91 to 0.98) and OR 0.99 (95 per cent c.i. 0.99-0.99)), and a reduction in duration of postoperative stay (incidence rate ratio (IRR) 0.98 (95 per cent c.i. 0.97 to 0.98) and IRR 0.99 (95 per cent c.i. 0.99 to 0.99)).
Outcomes of OG cancer surgery have improved over time, despite little evidence of improvements in early diagnosis. The underlying drivers for improvements in outcome are multifactorial.
国家食管胃肿瘤审计（NOGCA）从诊断到英格兰和威尔士所有 OG 癌症患者的初始治疗结束时，都会采集患者数据。本研究评估了 2012-2020 年期间 OG 癌症手术患者特征、治疗方法和结果的变化，并研究了在此期间哪些因素可能导致临床结果的变化。
纳入 2012 年 4 月至 2020 年 3 月期间诊断为 OG 癌症的患者。使用描述性统计来总结患者人口统计学、疾病部位、类型和分期、治疗模式以及随时间的变化。纳入手术量、手术方法和新辅助治疗的治疗变量。使用回归模型检查手术结果（住院时间和死亡率）与患者和治疗变量之间的关联。
研究期间共纳入 83393 名 OG 癌症患者。患者人口统计学和诊断时的癌症分期随时间变化不大。共有 17650 名患者接受了根治性治疗手术。这些患者的癌症分期越来越晚，并且在最近几年中，合并症的可能性也越来越大。死亡率和住院时间明显下降，同时肿瘤学结果（淋巴结产量和边缘阳性率）也有所改善。调整患者和治疗变量后，审计年份和信托基金量的增加分别与术后结果的改善相关：30 天死亡率降低（优势比（OR）0.93（95%置信区间 0.88 至 0.98）和 OR 0.99（95%置信区间 0.99-0.99））和 90 天死亡率降低（OR 0.94（95%置信区间 0.91 至 0.98）和 OR 0.99（95%置信区间 0.99-0.99）），以及术后住院时间缩短（发病率比（IRR）0.98（95%置信区间 0.97 至 0.98）和 IRR 0.99（95%置信区间 0.99 至 0.99））。
尽管早期诊断方面的改善证据很少，但 OG 癌症手术的结果随着时间的推移有所改善。结果改善的根本原因是多方面的。
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