胃腺癌患者康复后生存情况与背景人群的比较

Survival among patients cured from gastric adenocarcinoma compared to the background population

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Gastric Cancer

影响因子:5.1

分区:医学2区 / 胃肠肝病学2区肿瘤学2区

发表日期:2024 Nov

作者: Wilhelm Leijonmarck, Fredrik Mattsson, Jesper Lagergren

DOI: 10.1007/s10120-024-01545-y

摘要

目前尚不清楚胃腺癌幸存者的生存期是长于、短于还是与背景人群相当。这一认知有助于制定循证的监测策略、健康护理建议以及为患者和家属提供信息。本队列研究基于瑞典2006至2015年间接受胃切除术治疗的所有胃腺癌患者，筛选出术后存活≥5年的患者。随访直至死亡、术后第10年或研究结束（2020年12月31日）。通过生命表法计算观察到的生存率与预期生存率的比值（相对生存率）及其95%置信区间（CI），预期生存率来自瑞典整个对应年龄、性别和年份的人群数据。数据来源于医疗记录和全国性登记。所有767名胃腺癌幸存者的生存期均短于预期。相对生存率随随访年数增加而下降，从第6年97.3%（95% CI 95.4-99.1%）降至第10年86.6%（95% CI 82.3-90.9%）。早期年度（2011-2015）接受胃切除的患者在第10年的相对生存率更低（82.9% [95% CI 77.4-88.4%]），教育水平较低者（≤9年）亦较低（85.2% [95% CI 77.4-93.0%]），合并症较多者（Charlson合并症评分≥2）更低（78.0% [95% CI 63.9-92.0%]），未接受新辅助治疗者（83.2% [95% CI 77.4-89.0%]）。总的来看，胃腺癌幸存者的生存率低于对应的背景人群，尤其在某些亚组中更为明显。

Abstract

It is unknown if gastric adenocarcinoma survivors have longer, shorter, or similar survival compared to the background population. This knowledge could contribute to evidence-based monitoring strategies, healthcare recommendations, and information for patients and families.This population-based cohort study included all patients who underwent gastrectomy for gastric adenocarcinoma between 2006-2015 in Sweden and survived ≥ 5 years after surgery. They were followed up until death, postoperative year 10, or end of study period (31 December, 2020). Division of the observed by the expected survival yielded relative survival rates with 95% confidence intervals (CIs) using the life table method. The expected survival was derived from the entire Swedish population of the corresponding age, sex, and calendar year. Data came from medical records and nationwide registers.The survival among all 767 gastric adenocarcinoma survivors was shorter than the expected. The reduction in relative survival increased for each follow-up year, from 97.3% (95% CI 95.4-99.1%) year 6 to 86.6% (95% CI 82.3-90.9%) year 10. The decline in relative survival was more pronounced among patients who had gastrectomy in earlier calendar years (82.9% [95% CI 77.4-88.4%] year 10 for years 2011-2015), shorter education (85.2% [95% CI 77.4-93.0%] year 10 for education ≤ 9 years), more comorbidities (78.0% [95% CI 63.9-92.0%] year 10 for Charlson comorbidity score ≥ 2), and no neoadjuvant therapy (83.2% [95% CI 77.4-89.0%] year 10).Gastric adenocarcinoma survivors seem to have poorer survival than the corresponding background population, particularly in certain subgroups.