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Survival trends of patients with non-metastatic gastric adenocarcinoma in the US and European countries:the impact of decreasing resection rates

查看全文 作　　者：Lei [1,2]Huang;Lina [1,3]Jansen;Rob [4,5]H.A.Verhoeven;Jelle [6]P.Ruurda;Liesbet Van [7]Eycken;Harlinde De [7]Schutter;Jan [8]Johansson;Mats [9]Lindblad;Tom [10]B.Johannesen;Vesna [11]Zadnik;Tina [11]Zagar;Sjoerd [12]M.Lagarde;Cornelis J.Hvan de [13]Velde;Petra Schrotz-[14]King;Hermann [1,3,14]Brenner 高影响力作者 机构地区：[1]Division of Clinical Epidemiology and Aging Research,German Cancer Research Center(DKFZ),Heidelberg 69120,Germany;[2]Medical Faculty Heidelberg of Heidelberg University,Heidelberg 69120,Germany;[3]German Cancer Consortium,German Cancer Research Center,Heidelberg 69120,Germany;[4]Department of Research&Development,Netherlands Comprehensive Cancer Organization,Utrecht 3501 DB,The Netherlands;[5]Department of Medical Oncology,Amsterdam University Medical Centers,Amsterdam 1105 AZ,The Netherlands;[6]Department of Surgery,University Medical Center Utrecht,Utrecht 3508 GA,The Netherlands;[7]Belgian Cancer Registry,Brussels B-1210,Belgium;[8]Department of Esophageal and Gastric Surgery,Lund University Hospital,Lund 22185,Sweden;[9]Department of Clinical Science,Intervention,and Technology,Division of Surgery,Karolinska University Hospital,Stockholm 17176,Sweden;[10]Registry Department,The Cancer Registry of Norway,Oslo 0379,Norway;[11]Epidemiology and Cancer Registry,Institute of Oncology Ljubljana,Ljubljana 1000,Slovenia;[12]Department of Surgery,Erasmus Medical Centre-University Medical Centre Rotterdam,Rotterdam 3015 CE,The Netherlands;[13]Department of Surgical Oncology,Leiden University Medical Center,Leiden 2300 RC,The Netherlands;[14]Division of Preventive Oncology,German Cancer Research Center and National Center for Tumor Diseases,Heidelberg 69120,Germany高影响力机构 出　　处：《Cancer Communications》索引2022年第42卷第7期,共15页高影响力期刊 基　　金：Deutsche Krebshilfe. 摘　　要：Background:We previously observed decreasing resection rates of nonmetastatic gastric adenocarcinoma(GaC)in the US and some European countries.If and to what extent these trends affect the trends in overall survival(OS)of patients with non-metastatic GaC at the population level remain unclear.This large international population-based cohort study aimed to assess the impact of the previously observed decreasing resection rates on multivariable-adjusted trends in the long-term OS of patients with non-metastatic GaC.Methods:Individual-level data of patients with non-metastatic GaC were obtained from the national cancer registries of the Netherlands,Belgium,Sweden,Norway,and Slovenia,and the US Surveillance,Epidemiology,and End Results database.We analyzed data for each country separately.Associations between year of diagnosis and OS were assessed using Cox proportional hazards regression model with adjustment for multiple prognostic variables,with and without including resection and chemotherapy as potential explanatory variables.Results:A total of 66,398 non-metastatic GaC patients diagnosed in 2003-2016 were analyzed,with an accumulated follow-up of 172,357 person-years.Without adjustment for resection,OS was improved only slightly in the US[hazard ratio(HR)_(per year)=0.99;HR_(≥vs.<2010)=0.96],and no improvement was observed in the investigated European countries,with OS even worsening in Sweden(HR_(per year)=1.03;HR_(≥vs.<2010)=1.17).After adjusting for resection,the increasing OS trend became stronger in the US(HR_(per year)=0.98;HR_(≥vs.<2010)=0.88),and the temporal trend became insignificant in Sweden.In Slovenia(HR_(per year)=0.99;HR_(≥vs.<2010)=0.92)and Norway(HR_(per year)=0.97;HR_(≥vs.<2010)=0.86),improved OS over time emerged after resection adjustment.Improved OS in patients undergoing resection was observed in the US,the Netherlands,and Norway.Adjustment for chemotherapy did not alter the observed associations.Stratified analyses by tumor location showedmostly similar resultswith the findings in all patients with non-metastatic GaCs regarding the associations between year of diagnosis and survival.Conclusions:OS of patients with non-metastatic GaC mostly did not improve in selected European countries and was even worsened in Sweden,while it was slightly increased in the US in the early 21st century.Progress in OS of patients with non-metastatic GaC seems to have been impeded to a large extent by decreasing rates of resection. 关 键 词：gastric adenocarcinoma resection rate adjusted overall survival temporal trend prognostic factors international population-based cohort study
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