智利胆囊切除术与消化系统癌症：中断时间序列与汇总数据分析的补充性结果

Cholecystectomy and digestive cancer in Chile: Complementary results from interrupted time series and aggregated data analyses

INTERNATIONAL JOURNAL OF CANCER

影响因子:4.7

分区:医学2区 / 肿瘤学2区

发表日期:2025 Jan 01

作者: Constanza Gonzalez, Alfonso García-Pérez, Bruno Nervi, César Munoz, Erik Morales, Hector Losada, Gina Merino-Pereira, Francisco Rothhammer, Justo Lorenzo Bermejo

DOI: 10.1002/ijc.35138

摘要

智利的胆囊癌（GBC）死亡率位居全球前列。2006年，智利政府启动一项保障35-49岁患者接受胆囊切除术（cholecystectomy）的项目。我们评估了该项目对消化系统癌症死亡率的影响。通过对2002年至2018年间由智利卫生统计信息部门公开的住院和死亡数据进行中断时间序列分析，计算了10年内无胆囊人群比例的变化。随后，估算了按年龄、性别、地区和年份标准化的死亡比（SMRs）与无胆囊比例的变化关系。胆囊切除率在该健康项目实施后每年增加45例/10万人（95% CI 19-72）。每增加1%的无胆囊比例，胆囊癌死亡率降低0.73%（95% CI -1.05%至-0.38%）；然而，负相关主要局限于女性、南部地区和年龄超过60岁人群。还观察到肝外胆管、肝脏、食管和胃癌的死亡率随无胆囊比例升高而下降。综上，智利胆囊切除计划实施12年后，胆囊切除率显著且具有异质性变化。基于汇总数据的分析显示，无胆囊比例与胆囊癌及其他消化系统癌症的死亡率呈负相关，但需使用个体长期随访数据验证，以减少生态偏差的潜在影响。

Abstract

Gallbladder cancer (GBC) mortality in Chile is among the highest worldwide. In 2006, the Chilean government launched a programme guaranteeing access to gallbladder surgery (cholecystectomy) for patients aged 35-49 years. We evaluated the impact of this programme on digestive cancer mortality. After conducting an interrupted time series analysis of hospitalisation and mortality data from 2002 to 2018 publicly available from the Chilean Department of Health Statistics and Information, we calculated the change in the proportion of individuals without gallbladder since 10 years. We then estimated age, gender, region, and calendar-year standardised mortality ratios (SMRs) as a function of the change in the proportion of individuals without gallbladder. The cholecystectomy rate increased by 45 operations per 100,000 persons per year (95%CI 19-72) after the introduction of the health programme. Each 1% increase in the proportion of individuals without gallbladder since 10 years was associated with a 0.73% decrease in GBC mortality (95% CI -1.05% to -0.38%), but the negative correlation was limited to women, southern Chile and age over 60. We also found decreasing mortality rates for extrahepatic bile duct, liver, oesophageal and stomach cancer with increasing proportions of individuals without gallbladder. To conclude, 12 years after its inception, the Chilean cholecystectomy programme has markedly and heterogeneously changed cholecystectomy rates. Results based on aggregate data indicate a negative correlation between the proportion of individuals without gallbladder and mortality due to gallbladder and other digestive cancers, which requires validation using individual-level longitudinal data to reduce the potential impact of ecological bias.