日本2014-2021年恶性胃肿瘤内镜、腹腔镜及外科切除的临床流行病学：基于国家医疗保险数据的回顾性研究

Clinical epidemiology of the endoscopic, laparoscopic, and surgical resection of malignant gastric tumors in Japan, 2014-2021: a retrospective study using open data from a national claims database

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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:2025 Jan

作者: Akahito Sako, Tomoyuki Yada, Keiichi Fujiya, Ryo Nakashima, Kensuke Yoshimura, Hidekatsu Yanai, Naomi Uemura

DOI: 10.1007/s10120-024-01553-y

摘要

胃癌是一种在东亚地区高发的常见恶性肿瘤。胃切除方式包括内镜下切除到开腹全胃切除，但缺乏全国性数据。本观察性研究分析了日本公开数据的国家健康保险索赔及特定健康检查数据库，涵盖大部分全国医疗保险索赔数据，调查2014年至2021年间恶性胃肿瘤手术类型的变化、患者年龄和性别分布以及地区差异。结果显示，手术年度最高为2015年（109,000例），最低为2020年（9万例），疫情影响下有所下降。内镜切除比例由2014年的47%增加到2021年的57%，而全胃切除比例由17%下降到10%。2021年，接受手术的患者中70%为男性。同年，83.8%的所有手术患者及87.1%的内镜粘膜下剥离术患者年龄≥65岁。每百万人口的胃切除年发病率最高为鸟取县（1236例），最低为冲绳县（251例）。内镜切除比例最高的地区为宫城（66%），最低的为爱知（45%），而开放手术比例最高的为青森（36%），最低为和歌山（5%）。总体而言，胃癌治疗趋向于内镜下粘膜下剥离术，少用开腹全胃切除，但地区差异依然存在。需规范治疗方案，提升专业人员分布的均衡性。

Abstract

Gastric cancer is a common malignancy with a high incidence in East Asia. Gastric resection ranges from endoscopic resection to open total gastrectomy. However, nationwide data are lacking.This observational study analyzed data from the publicly accessible National Database of Health Insurance Claims and Specific Health Checkups, which includes most national health insurance claims data in Japan. Trends in the types of resection performed for malignant gastric tumors between 2014 and 2021, patients' age and sex distributions, and regional disparities were investigated.The annual number of resections was highest in 2015 (109,000) and lowest in 2020 (90,000) after the COVID-19 pandemic. The proportion of endoscopic resections increased from 47% in 2014 to 57% in 2021 while that of total gastrectomies decreased from 17 to 10%. In 2021, 70% of patients who underwent resection were men. That year, 83.8% of all patients who underwent any type of gastric resection and 87.1% of those who underwent endoscopic submucosal dissection were aged ≥ 65 years. The annual incidence of gastric resection per million population was highest in Tottori (n = 1236) and lowest in Okinawa (n = 251). The proportion of endoscopic resections was highest in Miyagi (66%) and lowest in Aichi (45%) and that of open surgery was highest in Aomori (36%) and lowest in Wakayama (5%).Gastric malignancy is increasingly treated by endoscopic submucosal dissection rather than open total gastrectomy. However, regional disparities remain in resection type. Standardization of treatment and a more even distribution of specialists are needed.