Department of Gastroenterology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China.
Medicine (Baltimore). 2023 Nov 24;102(47):e36261. doi: 10.1097/MD.0000000000036261.
Currently, little knowledge about the survival of early-onset gastric cancer and little evidence about the difference of survival based on Lauren type has been reported. In order to investigate the difference, we conducted a retrospective study using the Surveillance, Epidemiology, and End Results (SEER) database and compared it comprehensively. SEER database was used to extracted patients and multiple imputation was utilized to fill blank data. Multivariate cox regression analysis and competing risk model were used to identify the risk factors of survival. K-M survival curve and propensity score matching (PSM) was applied to compare the difference of survival of patients based on Lauren type. Totally, we extracted 3932 EOGC patients including 2086 diffused type and 1846 intestinal type. K-M survival curve showed patients aged 20 to 29 had worse survival compared to patients aged at 30 to 45 years. The survival of EOGC patients would be greatly improved after surgery. Multivariate cox regression analysis revealed diffused type was an independent risk factor, as well as T stage, lymph node metastasis, tumor size (>5 cm) and metastasis, while surgery treatment and examined lymph nodes were protective factors. Multivariate competing risk regression model also showed diffused type was risk factor. We performed PSM by matching 1433 diffused EOGC with 1433 intestinal EOGC patients, finding patients with diffused type had a poorer survival. our results revealed that compared to diffused type EOGC, intestinal type was characterized by a better survival. EOGC should be attached more attention by clinicians.
目前，关于早期胃癌的生存情况知之甚少，也几乎没有基于 Lauren 分型的生存差异的证据。为了研究这种差异，我们使用监测、流行病学和最终结果（SEER）数据库进行了回顾性研究，并进行了全面比较。使用 SEER 数据库提取患者，并采用多重插补法填补空白数据。采用多变量 Cox 回归分析和竞争风险模型来确定生存的危险因素。K-M 生存曲线和倾向评分匹配（PSM）用于比较基于 Lauren 分型的患者生存差异。共提取了 3932 例 EOGC 患者，其中弥漫型 2086 例，肠型 1846 例。K-M 生存曲线显示，20-29 岁的患者比 30-45 岁的患者生存更差。手术治疗后 EOGC 患者的生存状况会大大改善。多变量 Cox 回归分析显示弥漫型是独立的危险因素，T 分期、淋巴结转移、肿瘤大小（>5cm）和转移也是独立的危险因素，而手术治疗和检查的淋巴结是保护因素。多变量竞争风险回归模型也显示弥漫型是危险因素。我们通过匹配 1433 例弥漫型 EOGC 与 1433 例肠型 EOGC 患者进行 PSM，发现弥漫型患者的生存较差。我们的结果表明，与弥漫型 EOGC 相比，肠型的生存情况更好。临床医生应该更加关注 EOGC。
