Free access

Research Article

13 September 2021

Outcomes of patients with nonmetastatic gastric adenocarcinoma according to perioperative treatment strategy: a real-world, population-based study

Author: Omar Abdel-Rahman https://orcid.org/0000-0002-5117-2502 [email protected]Author Info & Affiliations

Publication: Journal of Comparative Effectiveness Research

Volume 10, Number 15

https://doi.org/10.2217/cer-2021-0113

PDF OtherFormats

Abstract

Aim: To assess the survival outcomes of patients with nonmetastatic gastric cancer according to the type of perioperative treatment strategy used (surgery-only, adjuvant chemo-radiotherapy, adjuvant chemotherapy, perioperative chemotherapy) in a population-based setting. Materials & methods: Surveillance, Epidemiology and End Results research-plus database was explored, and patients with nonmetastatic gastric cancer who were treated with an oncologic surgery were reviewed. Multivariable Cox regression analysis was used to examine the impact of treatment strategy on overall and cancer-specific survival. Results: A total of 11,526 patients were found to be eligible and they were included in the current analysis. Looking at the percentages of different treatment strategies throughout the study years (2006–2017), the use of the following strategies increased: adjuvant chemotherapy (20.1 vs 10.6%), and perioperative chemotherapy (21.3 vs 0.5%); while the use of the following strategies decreased: surgery only (36.2 vs 58.2%), and adjuvant chemo-radiotherapy (22.4 vs 30.6%). Using multivariable Cox regression analysis, the following factors were associated with worse overall survival: older age (hazard [HR]: 1.021; 95% CI: 1.018–1.023), males (HR: 1.09; 95% CI: 1.04–1.14), Black race (HR: 1.11; 95% CI: 1.04–1.19), cardia subsite (HR: 1.09; 95% CI: 1.02–1.17), grade 3–4 (HR:1.32; 95% CI: 1.25–1.40), diffuse histology (HR: 1.46; 95% CI: 1.35–1.58), clinically node positive (HR:1.43; 95% CI: 1.34–1.53), total gastrectomy (HR: 1.20; 95% CI: 1.13–1.28), and surgery-only approach (HR: 1.65; 95% CI: 1.55–1.75). Conclusion: Among patients with localized gastric cancer, patients who were treated with surgery-only, and to a less extent, patients who were treated with surgery followed by adjuvant chemotherapy have worse survival outcomes; while those treated with perioperative chemotherapy have the best survival outcomes.

Supplementary Material

File (suppl_file.docx)

Download
12.75 KB

References

Papers of special note have been highlighted as: • of interest

1.

Karimi P, Islami F, Anandasabapathy S, Freedman ND, Kamangar F. Gastric cancer: descriptive epidemiology, risk factors, screening, and prevention. Cancer Epidemiol. Biomarkers Prev. 23(5), 700–713 (2014).

2.

Guggenheim DE, Shah MA. Gastric cancer epidemiology and risk factors. J. Surg. Oncol. 107(3), 230–236 (2013).

3.

Machlowska J, Baj J, Sitarz M, Maciejewski R, Sitarz R. Gastric cancer: epidemiology, risk factors, classification, genomic characteristics and treatment strategies. Int. J. Mol. Sci. 21(11), 4012 (2020).

4.

Giryes A, Oweira H, Mannhart M, Decker M, Abdel-Rahman O. Exploring the differences between early-onset gastric cancer and traditional-onset gastric cancer. J. Gastrointest. Oncol. 9(6), 1157–1163 (2018).

5.

Choi AH, Kim J, Chao J. Perioperative chemotherapy for resectable gastric cancer: MAGIC and beyond. World J. Gastroenterol. 21(24), 7343–7348 (2015).

6.

Aoyama T, Yoshikawa T. Adjuvant therapy for locally advanced gastric cancer. Surg. Today 47(11), 1295–1302 (2017).

7.

Ronellenfitsch U, Schwarzbach M, Hofheinz R et al. Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: systematic review with meta-analysis combining individual patient and aggregate data. Eur. J. Cancer 49(15), 3149–3158 (2013).

8.

Beeharry MK, Zhang TQ, Liu WT, Gang ZZ. Optimization of perioperative approaches for advanced and late stages of gastric cancer: clinical proposal based on literature evidence, personal experience, and ongoing trials and research. World J. Surg. Oncol. 18(1), 51 (2020).

9.

Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Stat Database: Incidence - SEER Research Plus Data, 18 Registries, Nov 2019 Sub (2000–2017) - Linked To County Attributes - Total U.S., 1969–2018 Counties. National Cancer Institute, DCCPS, Surveillance Research Program (2020). www.seer.cancer.gov

10.

MacDonald JS, Smalley SR, Benedetti J et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N. Engl. J. Med. 345(10), 725–730 (2001).

11.

Noh SH, Park SR, Yang H-K et al. Adjuvant capecitabine plus oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): 5-year follow-up of an open-label, randomised Phase III trial. Lancet Oncol. 15(12), 1389–1396 (2014).

12.

Cunningham D, Allum WH, Stenning SP et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N. Engl. J. Med. 355(1), 11–20 (2006).

13.

Al-Batran S-E, Homann N, Pauligk C et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): a randomised, Phase II/III trial. Lancet 393(10184), 1948–1957 (2019).

14.

Cats A, Jansen EPM, Van Grieken NCT et al. Chemotherapy versus chemoradiotherapy after surgery and preoperative chemotherapy for resectable gastric cancer (CRITICS): an international, open-label, randomised Phase III trial. Lancet Oncol. 19(5), 616–628 (2018).

15.

Abdel-Rahman O. Impact of socioeconomic status on presentation, treatment and outcomes of patients with pancreatic cancer. J. Comp. Eff. Res. 9(17), 1233–1241 (2020).

16.

David R, Collins JW Jr. Why does racial inequity in health persist? J. Perinatol. 41(2), 346–350 (2021).

17.

Abdel-Rahman O. Asian Americans have better outcomes of non-metastatic gastric cancer compared to other United States racial groups: a secondary analysis from a randomized study. World J. Gastrointest. Oncol. 11(12), 1151–1160 (2019).

18.

Pietrantonio F, Miceli R, Raimondi A et al. Individual patient data meta-analysis of the value of microsatellite instability as a biomarker in gastric cancer. J. Clin. Oncol. 37(35), 3392–3400 (2019).

• Evaluates the impact of microsatellite instability status on the outcomes of nonmetatstatic gastric cancer in the setting of different perioperative treatment strategies.

|