國家衛生研究院 NHRI:Item 3990099045/15283
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    题名: Association of stage shift and prior gastroscopy in patients with gastric cancer
    作者: Yang, Y;Hu, H;Wang, T;Lee, Y;Chen, L
    贡献者: National Institute of Cancer Research
    摘要: Background:A previous study reported that gastric cancer patients received gastroscopy within 5 years prior to cancer diagnosis had significantly lower mortality in a region of low to moderate gastric cancer incidence. The reason remains speculative. The aims of this study are to identify the associations between stage shift and the frequency and time intervals of first gastroscopy before diagnosis, and to evaluate the possible risk-stratification schedule of gastroscopy.　Methods: This retrospective cohort study used government databases including Taiwan Cancer Registry (TCR), National Health Insurance Research Database (NHIRD) and Taiwan Death Registry (TDR). We identified gastric cancer patients (ICD-C-O: C16) from the TCR during 2007–2010 along with information of stages. We further identified death status and dates from TDR (2007-2012), and extracted patients’ history of gastroscopy and H. pylori eradication therapy, comorbidities and concomitant medications from NHIRD (2005-2011). We retrieved the numbers and dates of the first gastroscopy for any indications and excluded any gastroscopy within 30 days before the diagnosis of gastric cancer. Multivariable logistic regression was adopted to compute odds ratios (OR) and 95% confidence intervals for risk of late stage at diagnosis. Kaplan-Meier curves and Cox regressions are used to compute overall survival outcomes. Results: Among 7,772 gastric cancer patients, 40.3% are diagnosed of early stages (stages 1 or 2). There are 1,663 patients (21.4%) who received gastroscopy before cancer diagnosis and 53.6% of them at early stages. Among patients without prior gastroscopy, only 36.7% of them are at early stages. Using multivariable logistic regression to adjust possible confounding variables, having prior gastroscopy is associated with a lower chance (OR=0.52, 95% CI=0.46-0.58, p < 0.001) of diagnosed at late stages. There are also increasing trend of early-stage proportion and median survival time with respect to frequency of gastroscopies (no prior gastroscopy: 36.7% and 1.62 years, 1 time: 48.6% and 2.86 years, 2 times: 58.6% and 3.88 years, 3 times: 65.3% and 3.51 years, 4 times: 65.5% and 3.31 year, and 5+ times: 67.1% and 3.48 years). Considering the time intervals from the very first gastroscopy to the date of cancer diagnosis the proportion of early stage and median survival time show that time interval less than 1 year: 48.3% and 2.65 years, between 1-2 years: 55.2% and 3.30 years, between 2-3 years: 59.6% and 3.40 years, and 4 or more years: 56.7% and 3.49 years. Conclusions: Our results show that prior gastroscopy is associated with 48% of lower chance being discovered late-stage gastric cancer. Having 3 or more times of gastroscopy or having gastroscopy between 2-3 years before cancer diagnosis show approximately 60% of early stage diagnosis. Our study provides information of possible early detection of gastric cancer in terms of frequency and time intervals of prior gastroscopy. While using a real-world data setting, our results can contribute to future cancer screening policy making, and to serve as essential parameters for risk-stratification schedule of gastroscopy.
    日期: 2023-06
    關聯: Annals of Oncology. 2023 Jun;34(Suppl. 1):S99.
    Link to: http://dx.doi.org/10.1016/j.annonc.2023.04.291
    JIF/Ranking 2023: http://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=NHRI&SrcApp=NHRI_IR&KeyISSN=0923-7534&DestApp=IC2JCR
    Cited Times(WOS): https://www.webofscience.com/wos/woscc/full-record/WOS:001037960400236
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