Fisher S G, Davis F, Nelson R, Weber L, Goldberg J, Haenszel W
Department of Obstetrics and Gynecology, Loyola University Medical Center, Maywood, Ill. 60153.
J Natl Cancer Inst. 1993 Aug 18;85(16):1303-10. doi: 10.1093/jnci/85.16.1303.
For the past 40 years, investigators have suggested that there exists an increased risk of stomach cancer following gastric surgery for benign disease. Recent cohort studies have consistently identified an increased risk of stomach cancer beginning 20 years or more following gastric surgery. Validation of this association and elucidation of risk factors related to gastric cancer have been complicated by variability in study designs.
This cohort study was designed to investigate the risk of stomach cancer following gastric surgery and to identify patient and treatment characteristics that may alter this risk.
Medical admission records of 17077 male military veterans hospitalized during 1970-1971 in U.S. Department of Veterans Affairs (VA) hospitals were examined. From this initial cohort, 1094 patients who died within the 1st year following gastric surgery were excluded. Data analysis was performed on the final cohort consisting of 15,983 patients divided into the following two groups: 1) an exposed group (gastric surgery group) that included 7609 patients receiving gastric surgery for a documented benign disorder and 2) an unexposed group (comparison group) that included 8374 male patients randomly selected from all other hospitalized male patients in the patient database. The comparison group was matched to the gastric surgery group by age (within 10 years), race, hospital, and year of admission. Mortality follow-up utilized the following three sources to identify vital status: 1) the VA Patient Treatment File (1970-1988), 2) the VA Beneficiary Identification Record Linkage System (1970-1989), and 3) the National Death Index (1979-1988). Death certificates were obtained for 99% of the deceased patients. Analyses included estimations of risk using standardized rate ratios (SRRs) and proportional hazards techniques.
A statistically significant increase in risk of stomach cancer was demonstrated among males during the 20 years following gastric surgery (SRR = 1.9; 95% confidence interval [CI] = 1.3-2.4; P = .0001). The risk of developing gastric cancer was greatest during the 2nd to 5th postoperative years (SRR = 2.8; 95% CI = 1.6-4.5; P < .01) and during years 11-15 (SRR = 2.5; 95% CI = 1.2-4.8; P < .01). Also, the risk of developing gastric cancer was greatest among those treated by gastrectomy for any type of ulcer (SRR = 2.6; 95% CI = 1.2-4.9; P < .01) and those having any type of gastric surgery when the primary diagnosis was gastric ulcer (SRR = 2.9, 95% CI = 1.4-5.3; P < .01).
This study confirms that men undergoing gastrectomy for benign disease and men receiving any gastric surgery for gastric ulcer are at increased risk for developing gastric cancer. Unlike earlier studies, we find that the increased risk is not delayed for 20 years.
在过去40年里，研究人员指出，因良性疾病接受胃手术后患胃癌的风险会增加。最近的队列研究一致发现，胃手术后20年或更长时间患胃癌的风险会增加。研究设计的差异使得对这种关联的验证以及与胃癌相关风险因素的阐明变得复杂。
本队列研究旨在调查胃手术后患胃癌的风险，并确定可能改变这种风险的患者和治疗特征。
检查了1970 - 1971年在美国退伍军人事务部（VA）医院住院的17077名男性退伍军人的医疗入院记录。在这个初始队列中，排除了1094名在胃手术后第1年内死亡的患者。对最终队列进行数据分析，该队列由15983名患者组成，分为以下两组：1）暴露组（胃手术组），包括7609名因记录在案的良性疾病接受胃手术的患者；2）未暴露组（对照组），包括从患者数据库中所有其他住院男性患者中随机选取的8374名男性患者。对照组在年龄（10岁以内）、种族、医院和入院年份方面与胃手术组匹配。死亡率随访利用以下三个来源确定生命状态：1）VA患者治疗档案（1970 - 1988年），2）VA受益人识别记录链接系统（1970 - 1989年），3）国家死亡指数（1979 - 1988年）。99%的已故患者获得了死亡证明。分析包括使用标准化率比（SRR）和比例风险技术估计风险。
胃手术后20年内男性患胃癌的风险有统计学显著增加（SRR = 1.9；95%置信区间[CI] = 1.3 - 2.4；P = 0.0001）。患胃癌的风险在术后第2至5年最大（SRR = 2.8；95% CI = 1.6 - 4.5；P < 0.01）以及第11至15年最大（SRR = 2.5；95% CI = 1.2 - 4.8；P < 0.01）。此外，因任何类型溃疡接受胃切除术的患者患胃癌的风险最大（SRR = 2.6；95% CI = 1.2 - 4.9；P < 0.01），以及当主要诊断为胃溃疡时接受任何类型胃手术的患者患胃癌的风险最大（SRR = 2.9，95% CI = 1.4 - 5.3；P < 0.01）。
本研究证实，因良性疾病接受胃切除术的男性以及因胃溃疡接受任何胃手术的男性患胃癌的风险增加。与早期研究不同，我们发现风险增加并非延迟20年。
