以大型单中心医院登记为基础的6 737例接受手术切除的胃癌患者的生存报告

doi:10.19401/j.cnki.1007-3639.2024.03.004

摘要/Abstract

摘要：

背景与目的：收集以医院登记为基础的6 737例接受手术切除的胃癌患者的随访资料，分析其1、3和5年观察总生存（overall survival，OS）率和无病生存（disease-free survival，DFS）率，为中国的胃癌防控和政策制定提供真实世界研究证据。方法：纳入2015年1月1日—2020年12月31日在复旦大学附属肿瘤医院接受手术治疗的胃癌患者共6 737例，通过查阅患者病史了解患者的临床信息，并通过复诊病史、电话随访和死因数据链接等方式收集患者的生存随访资料，随访统计时间截至2023年11月30日。采用Kaplan-Meier法估计患者1、3和5年OS率和DFS率，并在不同年龄组、性别、治疗时期、肿瘤分期及病理学特征等亚组中分别描述。结果：接受手术切除的胃癌患者经中位50.99个月随访后，5年OS率和Ⅰ ~ Ⅲ期患者5年DFS率分别为70.37%和69.46%。Ⅰ期、Ⅱ期、Ⅲ期和Ⅳ期胃癌患者的5年OS率分别为94.32%、82.56%、51.01%和23.97%。不同年龄、部位、大体分型、Borrmann分型和Lauren分型的患者生存有显著差异。结论：肿瘤分期是影响胃癌患者生存的重要因素，应加强人群（尤其是高危人群）胃癌的筛查和早诊早治，进一步改善患者的生存。

关键词: 胃癌, 总生存率, 无病生存率, 医院登记

Abstract:

Background and purpose: Follow-up data of 6 737 patients undergoing surgery for gastric cancer were collected based on hospital registration, and the 1-, 3- and 5-years observed overall survival (OS) rates and disease-free survival (DFS) rates were analyzed to provide real-world research evidence for the prevention and control of gastric cancer and policy making in China. Methods: A total of 6 737 gastric cancer patients who underwent surgical treatment at Fudan University Shanghai Cancer center from 2015 to 2020 were included in this study. Clinical information and the follow-up endpoint data were collected through medical records review, telephone visits and death registry data linkage. The last follow-up date was November 30, 2023. Kaplan-Meier method was applied in evaluating the 1-, 3- and 5-year OS rate and DFS rate, and survival data were described by different subgroups including age group, gender, treatment period, tumor staging, and pathological characteristics. Results: With a median follow-up time of 50.99 months, the 5-year OS rate of surgically resected gastric cancer patients was 70.37%, and 5-year DFS rate in Ⅰ-Ⅲ stage cases was 69.46%. The 5-year OS rates of stage Ⅰ, Ⅱ, Ⅲ and Ⅳ were 94.32%, 82.56%, 51.01% and 23.97%, respectively. The differences in survival among patients with different age, tumor location, gross classification, Borrmann classification and Lauren classification were significant. Conclusion: Staging is an important factor directly affecting the survival of gastric cancer patients. Screening and early diagnosis and treatment in large population, especially high-risk group, should be strengthened to further improve the patients’ survival.

Key words: Gastric Cancer, Overall survival, Disease-free survival, Hospital-based registry

中图分类号:

R735.2

沈洁, 王江立, 王泽洲, 莫淼, 周昌明, 袁晶, 徐大志, 郑莹. 以大型单中心医院登记为基础的6 737例接受手术切除的胃癌患者的生存报告[J]. 中国癌症杂志, 2024, 34(3): 268-277.

SHEN Jie, WANG Jiangli, WANG Zezhou, MO Miao, ZHOU Changming, YUAN Jing, XU Dazhi, ZHENG Ying. Survival analysis of 6 737 surgically resected gastric cancer cases in China from a large single institution hospital-based cancer registry database[J]. China Oncology, 2024, 34(3): 268-277.

图/表 3

表1

表2

2015—2020年接受手术切除的胃癌患者的OS率（N = 6 737）"

Characteristic	Observation n	Death n	Median follow-up time (95% CI)/month	1-year OS rate (95% CI)/%	3-year OS rate (95% CI)/%	5-year OS rate (95% CI)/%	P value
OS	6 737	1 684	50.99 (49.96, 52.02)	94.88 (94.34, 95.41)	78.51 (77.46, 79.56)	70.37 (69.08, 71.65)
Gender							0.077
Male	4 670	1 196	51.06 (49.79, 52.32)	94.58 (93.92, 95.24)	78.01 (76.75, 79.28)	69.77 (68.21, 71.32)
Female	2 067	488	50.69 (48.84, 52.55)	95.55 (94.64, 96.45)	79.62 (77.76, 81.48)	71.73 (69.44, 74.02)
Age/year							<0.001
≤44	648	128	52.04 (49.25, 54.83)	96.97 (95.63, 98.31)	83.17 (80.09, 86.24)	77.04 (73.29, 80.79)
45-54	1 304	267	52.76 (50.52, 55.01)	96.28 (95.23, 97.32)	83.43 (81.29, 85.57)	75.73 (72.98, 78.47)
55-64	2 333	531	52.70 (50.96, 54.44)	95.88 (95.06, 96.70)	80.43 (78.72, 82.14)	73.53 (71.45, 75.61)
65-74	1 987	555	47.54 (45.60, 49.48)	93.56 (92.46, 94.66)	75.41 (73.37, 77.44)	66.24 (63.72, 68.75)
>75	465	203	47.44 (42.92, 51.96)	88.49 (85.52, 91.46)	61.02 (56.23, 65.82)	45.48 (39.78, 51.17)
Site							<0.001
Cardia	1 496	478	51.38 (48.84, 53.93)	94.09 (92.87, 95.31)	73.68 (71.29, 76.07)	62.18 (59.23, 65.13)
Fundus	114	43	50.46 (44.32, 56.60)	88.18 (82.15, 94.21)	64.03 (54.52, 73.55)	54.10 (43.17, 65.02)
Pylorus	2 525	569	51.65 (50.04, 53.25)	94.72 (93.84, 95.61)	80.20 (78.55, 81.85)	73.44 (71.44, 75.44)
Corpus	2 558	572	49.74 (48.13, 51.35)	95.94 (95.16, 96.72)	80.78 (79.15, 82.42)	73.33 (71.28, 75.37)
N/A	44	22	51.29 (38.81, 63.76)	86.21 (75.96, 96.45)	50.90 (35.30, 66.49)	42.01 (24.77, 59.25)
Histology							0.686
Signet-ring cell carcinoma	739	184	50.14 (47.70, 52.57)	95.95 (94.51, 97.39)	77.77 (74.57, 80.97)	71.49 (67.70, 75.29)
Adenosquamous carcinoma	8	5	64.10 (5.55, 122.65)	85.71 (59.79, 100.00)	47.62 (5.71, 89.52)	47.62 (5.71, 89.52)
Mucinous Adenocarcinoma	82	61	50.40 (44.80, 56.00)	96.10 (91.78, 100.00)	80.12 (70.75, 89.49)	67.08 (55.26, 78.90)
Tubular adenocarcinoma	41	9	50.99 (34.38, 67.60)	92.50 (84.34, 100.00)	79.00 (66.01, 91.99)	73.74 (58.04, 89.43)
Adenocarcinoma	5 857	1 463	51.29 (50.13, 52.44)	94.76 (94.18, 95.34)	78.65 (77.53, 79.77)	70.31 (68.92, 71.69)
N/A	10	4	41.20 (20.61, 61.79)	90.00 (71.41, 100.00)	52.50 (17.41, 87.59)	52.50 (17.41, 87.59)
Cancer type							<0.001
Early	1 538	87	49.12 (47.29, 50.95)	99.05 (98.56, 99.55)	96.07 (95.03, 97.11)	93.81 (92.35, 95.27)
Progressive	4 116	1 312	51.78 (50.35, 53.21)	93.40 (92.62, 94.17)	72.37 (70.92, 73.83)	62.38 (60.63, 64.12)
N/A	1 083	285	50.46 (47.89, 53.04)	94.63 (93.26, 95.99)	77.44 (74.79, 80.09)	68.71 (65.44, 71.99)
Borrmann type^*							<0.001
Ⅰ	306	65	46.26 (41.20, 51.32)	92.80 (89.83, 95.76)	79.09 (74.13, 84.06)	72.48 (66.43, 78.54)
Ⅱ	602	104	55.79 (52.58, 58.99)	97.59 (96.34, 98.84)	86.55 (83.65, 89.46)	79.50 (75.68, 83.32)
Ⅲ	2 779	914	51.71 (50.07, 53.36)	93.62 (92.69, 94.54)	71.91 (70.13, 73.68)	61.24 (59.10, 63.38)
Ⅳ	429	229	51.35 (47.04, 55.66)	86.54 (83.26, 89.82)	51.27 (46.25, 56.29)	39.26 (33.81, 44.70)
Lauren type							<0.001
Intestinal	2 147	387	48.13 (46.44, 49.82)	97.08 (96.35, 97.81)	85.31 (83.68, 86.93)	77.02 (74.83, 79.22)
Diffuse	1 796	532	49.38 (47.87, 50.89)	93.62 (92.47, 94.76)	73.05 (70.86, 75.23)	64.61 (61.99, 67.24)
Mixed	1 760	451	45.01 (43.54, 46.48)	94.09 (92.97, 95.22)	76.22 (74.09, 78.35)	67.83 (65.13, 70.54)
N/A	1 034	314	87.95 (85.43, 90.47)	93.88 (92.40, 95.35)	78.06 (75.45, 80.67)	70.58 (67.63, 73.54)
p/ypTNM							<0.001
Ⅰ	1 718	87	51.06 (49.16, 52.95)	99.64 (99.35, 99.93)	96.80 (95.91, 97.69)	94.32 (92.98, 95.66)
Ⅱ	1 257	187	53.16 (51.00, 55.32)	98.01 (97.22, 98.80)	89.31 (87.47, 91.16)	82.56 (80.03, 85.08)
Ⅲ	2 139	913	54.47 (52.35, 56.59)	91.24 (90.03, 92.45)	64.71 (62.58, 66.83)	51.01 (48.54, 53.49)
Ⅳ	174	119	52.04 (45.72, 58.36)	84.39 (78.98, 89.80)	41.82 (34.19, 49.44)	23.97 (16.26, 31.67)
N/A	1 449	378	42.09 (40.13, 44.04)	93.28 (91.96, 94.60)	73.31 (70.82, 75.79)	68.02 (65.13, 70.91)
Period							0.335
2015-2017	2 945	864	70.24 (69.43, 71.06)	94.78 (93.97, 95.59)	79.06 (77.54, 80.58)	71.12 (69.39, 72.84)
2018-2020	3 792	820	39.79 (39.08, 40.50)	94.95 (94.24, 95.67)	77.96 (76.51, 79.41)	69.03 (66.85, 71.22)

表2

表3

2015—2020年Ⅰ~Ⅲ期接受手术切除的胃癌手术患者的DFS率（N = 6 375）"

Characteristic	Observation n	Event n	1-year DFS rate (95% CI)/%	3-year DFS rate (95% CI)/%	5-year DFS rate (95% CI)/%	P value
DFS	6 375	1 667	92.99 (92.35, 93.63)	76.72 (75.62, 77.82)	69.46 (68.15, 70.77)
Gender						0.002
Male	4 438	1 212	92.43 (91.63, 93.22)	76.05 (74.72, 77.38)	68.22 (66.62, 69.81)
Female	1 937	455	94.28 (93.23, 95.33)	78.25 (76.30, 80.21)	72.37 (70.08, 74.65)
Age/year						<0.001
≤44	599	122	94.13 (92.22, 96.05)	79.84 (76.44, 83.24)	77.22 (73.51, 80.92)
45-54	1 225	259	94.52 (93.22, 95.81)	81.20 (78.90, 83.51)	75.30 (72.57, 78.04)
55-64	2 218	536	94.41 (93.44, 95.38)	78.96 (77.17, 80.75)	72.30 (70.16, 74.43)
65-74	1 890	557	91.35 (90.06, 92.65)	73.52 (71.39, 75.64)	64.85 (62.27, 67.42)
>75	443	193	86.94 (83.72, 90.16)	61.73 (56.84, 66.62)	45.75 (39.88, 51.61)
Site						<0.001
Cardia	1 421	483	91.94 (90.50, 93.39)	70.54 (68.02, 73.06)	60.36 (57.37, 63.36)
Fundus	104	39	86.14 (79.40, 92.88)	63.67 (53.82, 73.52)	56.85 (45.97, 67.74)
Pylorus	2 385	554	93.46 (92.45, 94.47)	78.88 (77.15, 80.61)	73.02 (70.98, 75.05)
Corpus	2 427	572	93.63 (92.64, 94.62)	79.16 (77.44, 80.88)	72.13 (70.04, 74.23)
N/A	38	19	81.33 (68.86, 93.80)	52.79 (36.33, 69.26)	48.39 (31.19, 65.59)
Histology						0.502
Signet-ring cell carcinoma	709	184	93.31 (91.45, 95.18)	75.53 (72.18, 78.88)	70.63 (66.82, 74.43)
Adenosquamous carcinoma	8	3	85.71 (59.79, 100.00)	47.62 (5.71, 89.52)	47.62 (5.71, 89.52)
Mucinous Adenocarcinoma	73	23	94.12 (88.53, 99.71)	72.79 (61.69, 83.89)	59.70 (46.44, 72.95)
Tubular adenocarcinoma	40	9	87.18 (76.69, 97.67)	78.70 (65.54, 91.86)	73.46 (57.66, 89.26)
Adenocarcinoma	5 535	1 442	92.99 (92.31, 93.68)	77.00 (75.83, 78.18)	69.49 (68.07, 70.90)
N/A	10	6	90.00 (71.41, 100.00)	47.65 (15.88, 79.41)	47.65 (15.88, 79.41)
Type						<0.001
Early	1 518	105	98.49 (97.86, 99.12)	94.62 (93.41, 95.84)	91.85 (90.20, 93.50)
Progressive	3 834	1 273	90.94 (90.01, 91.86)	70.05 (68.52, 71.59)	61.67 (59.89, 63.45)
N/A	1 023	289	92.59 (90.96, 94.23)	75.73 (72.95, 78.51)	66.67 (63.31, 70.03)
Borrmann type^*						<0.001
Ⅰ	286	68	90.84 (87.42, 94.26)	76.81 (71.52, 82.09)	71.20 (64.99, 77.40)
Ⅱ	569	102	96.72 (95.23, 98.21)	85.94 (82.92, 88.96)	79.23 (75.33, 83.13)
Ⅲ	2 588	886	90.87 (89.74, 91.99)	69.10 (67.21, 70.98)	60.68 (58.51, 62.85)
Ⅳ	391	217	83.09 (79.31, 86.87)	48.69 (43.44, 53.94)	36.32 (30.68, 41.96)
Lauren type						<0.001
Intestinal	2 038	396	95.13 (94.17, 96.08)	83.57 (81.84, 85.30)	75.54 (73.26, 77.81)
Diffuse	1 687	522	91.61 (90.27, 92.96)	71.27 (68.98, 73.56)	63.93 (61.26, 66.59)
Mixed	1 656	435	92.65 (91.36, 93.93)	75.21 (72.99, 77.43)	67.99 (65.28, 70.70)
N/A	994	314	91.58 (89.84, 93.32)	74.81 (72.03, 77.59)	68.60 (65.56, 71.64)
p/ypTNM						<0.001
Ⅰ	1 711	118	99.03 (98.55, 99.50)	95.35 (94.28, 96.42)	91.59 (89.99, 93.20)
Ⅱ	1 226	203	96.35 (95.27, 97.42)	87.13 (85.12, 89.14)	80.92 (78.33, 83.50)
Ⅲ	2 058	969	86.93 (85.45, 88.40)	58.64 (56.42, 60.86)	47.72 (45.27, 50.16)
N/A	1 380	377	91.73 (90.24, 93.21)	72.50 (69.95, 75.05)	66.32 (63.31, 69.34)
Period						0.406
2015-2017	2 843	877	92.68 (91.71, 93.65)	75.83 (74.20, 77.45)	69.11 (67.33, 70.89)
2018-2020	3 532	790	93.25 (92.40, 94.09)	77.49 (75.99, 78.99)	69.19 (67.02, 71.37)

表3

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