Faraldsfræði tveggja Laurén-flokka kirtilfrumukrabbameina í maga á Íslandi árin 1990-2009

Translated title of the contribution: Epidemiology of the two types of gastric adenocarcinoma in Iceland according to the Laurén histological classification 1990-2009

Halla Sif Ólafsdóttir, Kristín K. Alexíusdóttir, Jón Gunnlaugur Jónasson, Sigrún Helga Lund, Thorvaldur Jónsson, Halla Skúladóttir

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Abstract

Inngangur: Magakrabbamein var algengasta krabbameinið á Íslandi upp úr miðri 20. öld en er nú einungis 2-3% krabbameina. Markmið þessarar rannsóknar var að gera faraldsfræðilegan samanburð á tveimur meginflokkum kirtilfrumukrabbameina í maga samkvæmt Laurén-vefjaflokkunarkerfinu, svokölluðum garnafrumu- og dreifkrabbameinum, á tímabilinu 1990-2009. Efniviður og aðferðir: Rannsóknin er afturskyggn. Frá Krabbameinsskrá voru fengnar upplýsingar um alla sem greindust með magakrabbamein á árunum 1990-2009. Lýsingar meinafræðings í vefjasvörum tekinna sýna og brottnuminna æxla voru yfirfarnar og flokkaðar samkvæmt Laurénvefjaflokkunarkerfinu. Sjúkraskrár tilfella sem flokkuðust með annaðhvort garnafrumu- eða dreifkrabbamein voru síðan yfirfarnar með tilliti til faraldsfræðilegra þátta. Niðurstöður: Alls greindust 730 einstaklingar með kirtilfrumukrabbamein í maga á tímabilinu. Þar af voru 447 flokkuð sem garnafrumukrabbamein og 168 sem dreifkrabbamein. Greiningaraldur tilfella með dreifkrabbamein var marktækt lægri en tilfella með garnafrumukrabbamein. Kynjahlutfall í hópi garnafrumukrabbameina var 2,3:1 (kk:kvk), en í hópi dreifkrabbameina 1,1:1 (kk:kvk). Útreiknað aldursstaðlað nýgengi garnafrumukrabbameina lækkaði um 0,92/100.000 íbúa á ári en nýgengi dreifkrabbameina um 0,12/100.000 íbúa á ári og var um marktækan mun að ræða. Miðgildi lifunar í hópi garnafrumukrabbameina var 23,7 mánuðir og í hópi dreifkrabbameina 20,6 mánuðir. Munur á lifun eftir Laurén-flokki var marktækur. Áhættuhlutfall andláts hjá sjúklingum með dreifkrabbamein borið saman við garnafrumukrabbamein var 1,31 (öryggisbil 1,03-1,67), leiðrétt fyrir aldri, kyni, stigi, greiningarári og niðurstöðu aðgerðar (róttæk, ekki róttæk eða ekki). Ályktun: Verulega hefur dregið úr nýgengi kirtilfrumukrabbameina í maga, en sú lækkun virðist að mestu bundin við Laurén-flokk garnafrumukrabbameina. Laurén-flokkun hefur forspárgildi varðandi horfur, þar sem horfur sjúklinga með dreifkrabbamein eru verri.
Background: In the mid twentieth century gastric cancer was the most common type of cancer in Iceland. In recent decades, however, the incidence rate of gastric cancer has decreased markedly and currently only represents 2-3% of cancer cases. The Laurén classification system classifies adenocarcinoma into two types, intestinal and diffuse. The main purpose of our study was to describe the epidemiology of the two types of gastric adenocarcinoma in Iceland between the years 1990- 2009. Methods: This is a retrospective cohort study. Information on patients diagnosed with gastric cancer in Iceland between 1990 and 2009 was collected from the population based Cancer Registry. Histological descriptions were reviewed and classified according to the Laurén classification system. The records of patients diagnosed with either having intestinal or diffuse adenocarcinomas were reviewed and epidemiological information gathered. Results: Between 1990 and 2009, 730 patients were diagnosed with gastric adenocarcinoma in Iceland, 447 had intestinal adenocarcinoma and 168 diffuse adenocarcinoma. Patients diagnosed with diffuse adenocarcinoma were significantly younger at diagnosis than those diagnosed with intestinal adenocarcinoma. The sex ratio for intestinal adenocarcinoma was 2.3:1 (M:F) and 1.1:1 (M:F) for diffuse adenocarcinoma. The incidence of intestinal adenocarcinoma decreased more rapidly than that of diffuse adenocarcinoma during this period (0.92/100,000 vs. 0.12/100,000). Median survival rates of intestinal and diffuse adenocarcinomas were 23.7 and 20.6 months, respectively. The difference in survival was found to be statistically significant. The hazard ratio between the two groups was 1.31 (CI 1.03-1.67), corrected for age, sex, stage, year of diagnosis and surgical outcome (radical, non-radical or no operation). Conclusion: The overall incidence rate of gastric cancer has decreased dramatically in the past 20 years. However, the reduction is largely limited to the intestinal adenocarcinoma sub-group. We conclude that the Laurén classification predicts prognosis in gastric adenocarcinoma with diffuse adenocarcinoma having worse prognosis.
Translated title of the contributionEpidemiology of the two types of gastric adenocarcinoma in Iceland according to the Laurén histological classification 1990-2009
Original languageIcelandic
Pages (from-to)125-130
Number of pages6
JournalLaeknabladid
Volume102
Issue number3
DOIs
Publication statusPublished - 2 Mar 2016

Other keywords

  • Magakrabbamein
  • Stomach Neoplasms
  • Classification
  • Survival
  • Incidence

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