Competing risk model analysis of factors influencing the death in patients with different primary sites of gastric cancer in SEER database
10.3760/cma.j.cn115355-20240426-00209
- VernacularTitle:SEER数据库不同原发部位胃癌患者死亡影响因素的竞争风险模型分析
- Author:
Rong GAO
1
;
Fangmei AN
;
Cheng YANG
;
Yuting WU
;
Zhijie LI
Author Information
1. 南京医科大学无锡医学中心 无锡市人民医院 南京医科大学附属无锡人民医院医学检验科，无锡 214023
- Publication Type:Journal Article
- Keywords:
Stomach neoplasms;
Cause of death;
Risk factors
- From:
Cancer Research and Clinic
2025;37(8):561-568
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the death risk of gastric cancer patients with different primary sites.Methods:The data of 35 263 gastric cancer patients from 2004 to 2015 were extracted from of the National Cancer Institute the Surveillance, Epidemiology, and End Results (SEER) database. According to the recorded causes of death, the treatment outcomes were classified into 3 categories: death from gastric cancer, death from non-gastric cancer and others. All included patients were grouped by age, gender, race, region, and marital status. Statistical analysis was conducted by using R 4.2.1 software to compare the composition of patients with different treatment outcomes at 3-year, 5-year, and 10-year in each factor subgroup. Univariate Fine-Gray competing model was used to analyze the cumulative incidence of death at 3-year, 5-year, and 10-year in gastric cancer patients with different primary sites. The 5 factors mentioned above were included in the multivariate Fine-Gray competing model to analyze the factors influencing the risk of death from gastric cancer in the entire population at 3-year, 5-year, and 10-year and in gastric cancer patients with different primary sites for 10 years in each factor subgroup after adjusting for demographic differences.Results:Among the entire population, there were 13 392 cases of cardia, 2 198 cases of gastric fundus, 4 510 cases of gastric body, 8 394 cases of antrum, 1 154 cases of pylorus, 3 633 cases of lesser curvature, and 1,982 cases of greater curvature. There were statistically significant differences in the composition of 3-year, 5-year, and 10-year treatment outcomes including death from gastric cancer, non-gastric cancer and other outcomes of gastric cancer patients stratified by different age, gender, race, region, marital status, and primary sites of tumors among subgroups (all P < 0.001). Univariate Fine-Gray model analysis showed that the cumulative incidence of death from gastric cancer was 29.0%, 30.9% and 31.6%, respectively at 3-year,5-year and 10-year after the confirmed diagnosis in gastric cancer patients with primary sites in the cardia, which was all lower than that in those with primary site in the gastric fundus (44.5%, 46.8%, 47.7%), the gastric body (49.1%, 46.8%, 53.5%), the antrum (51.4%, 54.7%, 56.1%), the pylorus (53.6%, 57.8%, 59.8%), the lesser curvature (44.4%, 48.4%, 50.0%), and the greater curvature (42.4%, 45.0%, 46.4%). Multivariate Fine-Gray model analysis showed that the 3-year, 5-year, and 10-year mortality risks of gastric cancer patients with the primary site in the cardia were all lower than those of patients with the primary sites in other locations (all HR > 1, P < 0.001); taking the 10-year death from gastric cancer as an example, the death risks of gastric cancer patients with the primary site in the fundus ( HR = 1.74, 95% CI: 1.62-1.86), gastric body ( HR = 2.03, 95% CI: 1.93-2.14), gastric antrum ( HR = 2.13, 95% CI: 2.04-2.23), pylorus ( HR = 2.28, 95% CI: 2.11-2.47), lesser curvature ( HR = 1.76, 95% CI: 1.67-1.86), and greater curvature ( HR = 1.64, 95% CI: 1.53-1.76) were all higher than those of patients with primary site in the cardia (all P < 0.001). The results of subgroup multivariate Fine-Gray model analysis showed that there were no statistically significant differences in the 10-year death risk of gastric cancer between gastric cancer patients with other primary sites and patients with primary site in the cardia in the age group under 30 years (gastric fundus, gastric body, gastric antrum, lesser curvature, greater curvature), the black group (gastric fundus and lesser curvature) and other races group (gastric fundus, greater curvature and lesser curvature)(all P > 0.05); the results of other subgroups were the same as those of the entire population, namely, the 10-year risk of death from gastric cancer in patients with primary site in the cardia was lower than that in patients without primary site in the cardia (all HR > 1, P < 0.05). Conclusions:In SEER database, the patients with primary site in the cardia has a lower risk of death from gastric cancer compared to those with other primary sites.
