METHODS: This retrospective cohort study utilized data from Korea\'s National Health Insurance Service, focusing on 30-59-year-old gastric cancer patients who received either surgery or endoscopic procedures from January 2009 to December 2013. The primary outcome measure was all-cause mortality. Early loss of EA was identified when a patient\'s insurance status shifted to dependent within one year following treatment. Adjusted hazard ratios (HRs) and 95% confidence intervals (CI) for all-cause mortality were estimated using multivariable Cox proportional hazards models, conducting separate analyses for surgical and endoscopic groups.
RESULTS: Among 24,159 patients (median follow-up, 9.9 years), 2976 (12.3%) experienced all-cause mortality. Specifically, 2835 of these deaths occurred in patients who underwent surgery, while 141 were in the endoscopic procedure group. Early loss of EA was recorded in 14.4% of the surgery group and 7.7% of the endoscopic procedure group. Adjusted HRs (95% CI) for all-cause mortality associated with early loss of EA were 1.39 (1.27-1.54) for the surgery group and 2.27 (1.46-3.52) for the endoscopic procedure group.
CONCLUSIONS: This study highlights a significant association between the early loss of EA and an increased risk of all-cause mortality in those who have undergone curative treatments for gastric cancer. It underscores the crucial role of sustaining EA in enhancing the health outcomes of these survivors.
方法:这项回顾性队列研究利用了韩国国民健康保险服务的数据,重点关注2009年1月至2013年12月接受手术或内镜手术的30-59岁胃癌患者.主要结局指标是全因死亡率。当患者的保险状态在治疗后一年内转变为依赖者时,可以确定EA的早期损失。使用多变量Cox比例风险模型估计全因死亡率的调整风险比(HR)和95%置信区间(CI)。分别对手术组和内窥镜组进行分析。
结果:在24,159例患者中(中位随访,9.9年),2976人(12.3%)出现全因死亡率。具体来说,这些死亡中有2835例发生在接受手术的患者中,而141人属于内镜手术组。在手术组的14.4%和内镜手术组的7.7%中记录到早期EA丢失。与早期EA丢失相关的全因死亡率的校正HR(95%CI)在手术组为1.39(1.27-1.54),在内镜手术组为2.27(1.46-3.52)。
结论:这项研究强调了在接受胃癌治疗的患者中,早期EA丧失与全因死亡风险增加之间的显著关联。它强调了维持EA在增强这些幸存者的健康结果方面的关键作用。