PubMed · 13686335
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E BALGAIRIES, D PREVOST. 1961. [Pneumoconiotuberculosis and gastrectomy].. https://pubmed.ncbi.nlm.nih.gov/13686335/
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BACKGROUND AND AIM: Especially in malign diseases, the therapeutic decision depends on the prognosis for the individual patient. A prognosis is a prediction of the future course of disease following its onset. Graphical representation of such statistical results-such as the well-known Kaplan-Meier curve-is often used to assist readers of a paper in the interpretation. However, mistakes and distortions frequently arise in the display and interpretation of survival plots. This review aims to highlight such pitfalls and provide recommendations for future practice. METHODS: Special topics are discussed: the criteria for the presentation of the survival curve, the problem of missing values, estimation of the prognosis in the presence of competing risks, comparison of treatment effects and analysis of survival by tumour-response category.
The past decade has seen many advances in knowledge about gastric cancer. Notably, tumour biology and lymphatic spread are now better understood, and treatment by surgical and medical oncologists has become more standardised. Since refrigerators have replaced other methods of food conservation, Helicobacter pylori has become a factor in the cause of gastric cancer. Cancers that arise at the oesophagogastric junction might be further examples of wealth-associated disease. To tailor treatment better, the western hemisphere needs to borrow from the East by establishing screening programmes for early diagnosis, through careful surgical resection, and through detailed analysis of tumour spread. In Europe and the USA, most patients reach treatment with cancers already at an advanced stage. For these patients, three important randomised trials are underway that evaluate combined therapy. Cytostatic drugs, especially angiogenesis inhibitors have proved disappointing; however, basic research efforts to detect familial gastric cancers and to assess minimally residual disease look more hopeful.
The incidence of gastric cancer and the need for subsequent surgery has been decreasing in the United States. However, very few population-based studies on the magnitude of these changes are available. The objective of the present study was to characterize temporal trends in the use of gastric resection in the treatment of gastric cancer. Patients with a primary diagnosis code for gastric cancer (N=105,887) and a procedure code for gastric resection (N=23,690) in the Nationwide Inpatient Sample for 1988-2000 were included. The Nationwide Inpatient Sample represents a 20% stratified random sample representative of all United States hospitals. Outcome variables included the overall incidence, in-hospital mortality rate, and length of stay. Rates of surgery are shown as the number of cases per 100,000 hospital discharges. Hospital volume was defined as follows: low volume (1 to 4 cases per year), medium volume (5 to 8 cases per year), and high volume (9 or more cases per year). Rates of gastric resection have shown a 20% decline from 30 cases per 100,000 (1988-1989) to 24 cases per 100,000 (1999-2000) (P=0.001). In-hospital mortality has not changed over the 13-year period and remains at 7.4%. There was significant variation in mortality across hospitals, with very low-volume centers having an 8.9% mortality rate, whereas very high-volume centers had a 6.4% mortality rate (P<0.001). The market share of gastric resections performed at high-volume centers increased a small amount from 43% (1988-1989) to 48% (1999-2000) (P=0.023). Over the 13-year period, length of stay decreased from 15 days (interquartile range [IQR] 11-23) in 1988 to 11 days (interquartile range [IQR] 8-16) in 2000 (P<0.001). Rates of gastric resection for cancer have shown a modest decline over the past 13 years in the United States. Although the length of stay for these patients has decreased, no significant changes to in-hospital mortality have occurred. Given the declining rates of gastric cancer surgery, and the superior outcomes at high-volume centers, regionalization of care may improve mortality rates for this high-risk surgical procedure.