食道癌的阶段依赖生存:丹麦全国性队列研究
Oliver Nørholm Kempf1, Lise Bech Jellesmark Thorsen2, Nikolaj Nerup1
1Department of Digestive Diseases, Transplantation and General Surgery, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
概括
食道癌的生存率因治疗而异. 手术提供了比化学放射治疗或息治疗更好的结果,尽管接受手术的IVb期患者的生存率惊人高.
科学领域:
- 在瘤学瘤学.
- 癌症研究 癌症研究
- 临床流行病学临床流行病学
背景情况:
- 食道癌是全球领先的恶性瘤,存活率很低.
- 尽管治疗进展,但对食道癌的准确预后仍然是一个挑战.
- 丹麦每年注册800多例病例,五年生存率为10%-15%.
研究的目的:
- 用国际癌症控制联盟 (UICC) 的分阶段系统绘制不同阶段的食道癌生存率.
- 根据治疗方式和组织学类型分析生存结果.
- 为改善临床决策和个性化治疗方案提供数据.
主要方法:
- 利用了丹麦食管胃癌组数据库 (2013-2021年),涵盖了99%的丹麦食管癌 (n=7855).
- 根据治疗方法和组织学分层患者,使用UICC瘤结节转移分类进行分期.
- 采用卡普兰-梅尔方法和考克斯比例危险回归来进行统计分析,以全因死亡率为终点.
主要成果:
- 绝对化疗放射治疗显示整体存活率 (OS) 低于手术治疗,但高于息治疗 (p<0.001).
- 在经过手术治疗的平细胞癌 (SCC) 患者中,在不同阶段 (p=0.25) 中没有发现显著的OS差异.
- 手术治疗的患者的生存状况比息治疗患者更好;特定的化疗方案 (5-FU,leucovorin,oxaliplatin,docetaxel) 显示了生存益处 (p=0.001).
- 在接受手术的IVb阶段患者中,一小组选择的患者表现出意想不到的高生存率.
结论:
- 该研究提供了基于丹麦综合数据库的食道癌生存结果的详细概述.
- 幸存率受到治疗方式的显著影响,手术通常比化学放射治疗或息治疗更好的结果.
- 这些发现可以帮助开发更多的个性化治疗策略,用于食道癌患者.
相关概念视频
Cancer Survival Analysis
455
Cancer survival analysis focuses on quantifying and interpreting the time from a key starting point, such as diagnosis or the initiation of treatment, to a specific endpoint, such as remission or death. This analysis provides critical insights into treatment effectiveness and factors that influence patient outcomes, helping to shape clinical decisions and guide prognostic evaluations. A cornerstone of oncology research, survival analysis tackles the challenges of skewed, non-normally...
455
Barrett Esophagus-I: Introduction
201
Barrett's esophagus is a medical condition where the esophageal mucosa is significantly damaged by stomach acid or other digestive fluids, often due to long-term exposure associated with gastroesophageal reflux disease (GERD). In GERD, a weakened or abnormally relaxed lower esophageal sphincter allows stomach acid to flow persistently into the esophagus.
This constant acid exposure transforms the esophagus's pink mucosal lining (stratified squamous epithelium) into a type of lining more...
This constant acid exposure transforms the esophagus's pink mucosal lining (stratified squamous epithelium) into a type of lining more...
201
Barrett Esophagus-II: Clinical Manifestations and Management
297
Individuals with Barrett's esophagus are often asymptomatic, but they may experience symptoms commonly associated with GERD, such as heartburn and acid regurgitation. Additional symptoms can include difficulty swallowing, chest pain, unintentional weight loss, blood in the stool (which may appear black, tarry, or bloody), and episodes of vomiting.
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure...
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure...
297
Actuarial Approach
135
The actuarial approach, a statistical method originally developed for life insurance risk assessment, is widely used to calculate survival rates in clinical and population studies. This method accounts for participants lost to follow-up or those who die from causes unrelated to the study, ensuring a more accurate representation of survival probabilities.
Consider the example of a high-risk surgical procedure with significant early-stage mortality. A two-year clinical study is conducted,...
Consider the example of a high-risk surgical procedure with significant early-stage mortality. A two-year clinical study is conducted,...
135
Esophageal Strictures-I: Introduction
267
Esophageal strictures involve abnormal narrowing or tightening of the esophagus. They vary in length and severity, ranging from mild constriction to complete obstruction, and are classified as benign (noncancerous) or malignant (cancerous).
Etiology
The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...
Etiology
The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...
267
Kaplan-Meier Approach
264
The Kaplan-Meier estimator is a non-parametric method used to estimate the survival function from time-to-event data. In medical research, it is frequently employed to measure the proportion of patients surviving for a certain period after treatment. This estimator is fundamental in analyzing time-to-event data, making it indispensable in clinical trials, epidemiological studies, and reliability engineering. By estimating survival probabilities, researchers can evaluate treatment effectiveness,...
264


