Analysis of the Incidence and Survival of Gastric Cancer Based on the Lauren Classification: A Large Population-Based Study Using SEER
Analysis of the Incidence and Survival of Gastric Cancer Based on the Lauren Classification: A Large Population-Based Study Using SEER
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DOI：
10.3389/fonc.2020.01212
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发表时间：
2020-08-03
影响因子：
4.7
通讯作者：
Chen, Youxiang
中科院分区：
文献类型：
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作者：
Tang, Chao-Tao;Zeng, Ling;Chen, Youxiang
背景：关于胃癌（GC）发病率的证据有限，并且基于 Lauren 分类的 GC 预后存在矛盾的结果。我们根据 Lauren 分类分析了 GC 的发生率和生存率。方法：使用 1975 年至 2015 年的监测、流行病学和最终结果 (SEER) 数据库来识别所有手术切除、组织学诊断为肠道或弥漫型 GC 的患者。使用倾向评分匹配来分析Lauren分类类型与预后之间的关联。结果：GC总发生率呈明显下降趋势（APC=-1.51，95%CI：-2.31～-1.01），肠型GC发生率（APC=-1.43，95%CI：-2.01～-1.12）呈明显下降趋势。然而，我们发现弥漫型的相对发生率有所增加（APC = 0.6，95% CI：0.41-0.82）。 40~49岁人群胃癌总发生率（APC=-1.31，95%CI：-1.91～-1.03）和肠型（APC=-1.11，95%CI：-1.53～-0.98）的趋势呈下降趋势，而弥漫型（APC=1.5，95%CI：-1.53～-0.98）则呈上升趋势。 1.2-1.72）。我们发现，区域期和远处期的胃癌发病率趋势相似，从 1975 年到 2015 年呈下降趋势。然而，局部期的发病率有所增加，APC 为 0.5（95% CI：0.3-0.7）。我们从 SEER 数据库中识别出 15,989 例胃癌病例，其中 13,852 例肠型和 2,138 例弥漫型病例。采用倾向评分匹配（PSM）将1,336例肠型病例与1,336例弥漫型病例进行匹配，弥漫型患者的预后优于肠型患者（HR = 0.56，95% CI：0.45-0.78）。然而，我们发现仁济医院队列中弥漫型GC患者的生存率比肠型GC患者差（P<0.001）。结论:40~49岁人群GC总发生率及肠型GC发生率下降,而弥漫型GC发生率上升。在不同的患者群体中，与肠型 GC 相比，弥漫型 GC 的预后可能不同。然而，在结合其他因素评估预后时应谨慎解释这些结果。
Background:Limited evidence exists on the incidence of gastric cancer (GC), and contradictory results exist for the prognosis of GC based on the Lauren classification. We analyzed the incidence and survival of GC based on the Lauren classification. Methods:The Surveillance, Epidemiology, and End Results (SEER) database from 1975 through 2015 was used to identify all patients with surgically resected, histologically diagnosed intestinal or diffused-type GC. Propensity score matching was used to analyze the association between the Lauren classification type and prognosis. Results:The trend of total GC incidence showed an obvious decrease (APC = -1.51, 95% CI: -2.31 to -1.01) as well as that of the intestinal type (APC = -1.43, 95% CI: -2.01 to -1.12). However, we found that the relative incidence of the diffused type was increased (APC = 0.6, 95% CI: 0.41-0.82). The trend of the total incidence of GC (APC = -1.31, 95% CI: -1.91 to -1.03) and that of the intestinal type (APC = -1.11, 95% CI: -1.53 to -0.98) was decreased in 40-49-year-olds, but that of the diffused type was increased (APC = 1.5, 95% CI: 1.2-1.72). We found that trends in GC incidence exhibited a similar pattern in the regional and distant stages and showed a decrease from 1975 through 2015. However, the incidence rate of the local stage was increased, with an APC of 0.5 (95% CI: 0.3-0.7). We identified 15,989 GC cases from the SEER database, including 13,852 intestinal-type and 2,138 diffused-type cases. The 1,336 intestinal-type cases were matched with 1,336 diffused-type cases using propensity score matching (PSM), and patients with the diffused type had a better prognosis than patients with the intestinal type (HR = 0.56, 95% CI: 0.45-0.78). However, we found that patients with diffused-type GC had worse survival than patients with intestinal-type GC in the cohort from Renji Hospital (P< 0.001). Conclusion:The total incidence of GC and that of the intestinal-type GC decreased, but the incidence of diffused-type GC increased in 40-49-year-olds. Diffused types of GCs may have a different prognosis compared to intestinal-type GCs in different patient cohorts. Nevertheless, these results should be interpreted with caution in assessing the prognosis in combination with other factors.