National Underutilization of Neoadjuvant Chemotherapy for Gastric Cancer.
Gastric cancer
Healthcare disparities
Multimodal treatment
Neoadjuvant chemotherapy
Surgical oncology
Journal
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
ISSN: 1873-4626
Titre abrégé: J Gastrointest Surg
Pays: United States
ID NLM: 9706084
Informations de publication
Date de publication:
04 2020
04 2020
Historique:
received:
28
06
2019
accepted:
19
10
2019
pubmed:
4
12
2019
medline:
15
4
2021
entrez:
4
12
2019
Statut:
ppublish
Résumé
Since the publication of the landmark MAGIC trial in 2006, neoadjuvant chemotherapy has become the standard of care for stage II/III gastric cancer. Nevertheless, many patients still do not begin their treatment with neoadjuvant chemotherapy. The objective of our study was to identify factors associated with underutilization of neoadjuvant chemotherapy for stage II/III gastric cancer. Patients with pathological stage II and III primary gastric cancer between 2004 and 2015 were identified from the American College of Surgeons National Cancer Database. Patients who received neoadjuvant chemotherapy were compared with those who underwent surgery only or surgery followed by chemotherapy. Predictors of receipt of neoadjuvant chemotherapy were identified using multivariable logistic regression model. Median survival was calculated for each treatment strategy. We included 15,947 patients with pathological stage II/III gastric cancer. The proportion of patients receiving neoadjuvant chemotherapy increased from less than 5% before 2006 to 27.5% in 2015. On multivariable analysis, factors associated with no receipt of neoadjuvant therapy included treatment year before 2006 and age greater than 80. Treatment at high-volume centers, academic research programs, or integrated network cancer programs and undergoing total/subtotal or en bloc gastrectomy predicted receipt of neoadjuvant chemotherapy. Ten years after the publication of the MAGIC trial, fewer than 1/3 of patients with stage II/III gastric cancer are receiving neoadjuvant chemotherapy, which has been shown to improve disease-specific survival. Further studies are needed to understand these disparities and ensure both patients and providers are having evidence-based discussions about multimodal therapy for gastric cancer.
Sections du résumé
BACKGROUND
Since the publication of the landmark MAGIC trial in 2006, neoadjuvant chemotherapy has become the standard of care for stage II/III gastric cancer. Nevertheless, many patients still do not begin their treatment with neoadjuvant chemotherapy. The objective of our study was to identify factors associated with underutilization of neoadjuvant chemotherapy for stage II/III gastric cancer.
METHODS
Patients with pathological stage II and III primary gastric cancer between 2004 and 2015 were identified from the American College of Surgeons National Cancer Database. Patients who received neoadjuvant chemotherapy were compared with those who underwent surgery only or surgery followed by chemotherapy. Predictors of receipt of neoadjuvant chemotherapy were identified using multivariable logistic regression model. Median survival was calculated for each treatment strategy.
RESULTS
We included 15,947 patients with pathological stage II/III gastric cancer. The proportion of patients receiving neoadjuvant chemotherapy increased from less than 5% before 2006 to 27.5% in 2015. On multivariable analysis, factors associated with no receipt of neoadjuvant therapy included treatment year before 2006 and age greater than 80. Treatment at high-volume centers, academic research programs, or integrated network cancer programs and undergoing total/subtotal or en bloc gastrectomy predicted receipt of neoadjuvant chemotherapy.
CONCLUSIONS
Ten years after the publication of the MAGIC trial, fewer than 1/3 of patients with stage II/III gastric cancer are receiving neoadjuvant chemotherapy, which has been shown to improve disease-specific survival. Further studies are needed to understand these disparities and ensure both patients and providers are having evidence-based discussions about multimodal therapy for gastric cancer.
Identifiants
pubmed: 31792901
doi: 10.1007/s11605-019-04439-y
pii: 10.1007/s11605-019-04439-y
pmc: PMC7486798
mid: NIHMS1616156
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
949-958Subventions
Organisme : NCI NIH HHS
ID : T32 CA090217
Pays : United States
Références
Surgery. 2016 Apr;159(4):1099-112
pubmed: 26704785
Int J Cancer. 2015 Mar 1;136(5):E359-86
pubmed: 25220842
Clin Interv Aging. 2014 Mar 19;9:433-41
pubmed: 24672230
Ann Surg Oncol. 2013 Feb;20(2):362-70
pubmed: 22890592
J R Soc Med. 2011 Dec;104(12):510-20
pubmed: 22179294
Ann Surg Oncol. 2008 Mar;15(3):683-90
pubmed: 18183467
PLoS One. 2017 Oct 26;12(10):e0183955
pubmed: 29073140
BMC Geriatr. 2017 Aug 21;17(1):188
pubmed: 28826406
N Engl J Med. 2006 Jul 6;355(1):11-20
pubmed: 16822992
Eur J Surg Oncol. 2013 Feb;39(2):171-8
pubmed: 22999411
Ann Surg Oncol. 2010 Dec;17(12):3077-9
pubmed: 20882416
Gastric Cancer. 2012 Jan;15(1):76-82
pubmed: 21717091
Ann Surg Oncol. 2013 May;20(5):1591-7
pubmed: 23104705
World J Gastroenterol. 2015 Jun 28;21(24):7343-8
pubmed: 26139980
J Surg Oncol. 2014 Sep;110(3):285-90
pubmed: 24891231
Epidemiol Prev. 2017 Sep-Dec;41(5-6 (Suppl 2)):1-128
pubmed: 29205995
N Engl J Med. 2006 Jul 6;355(1):76-7
pubmed: 16822999
Cancer Manag Res. 2018 Feb 07;10:239-248
pubmed: 29445300
JAMA Oncol. 2017 Sep 1;3(9):1237-1244
pubmed: 28448662
Cancer. 2017 Dec 15;123 Suppl 24:4994-5013
pubmed: 29205310
Milbank Q. 2002;80(3):569-93, v
pubmed: 12233250
Ann Surg Oncol. 2017 Aug;24(8):2291-2301
pubmed: 27770339
J Gastrointest Surg. 2018 Jun;22(6):955-963
pubmed: 29404983
Br J Surg. 2004 May;91(5):528-39
pubmed: 15122602
Int J Clin Oncol. 2013 Feb;18(1):10-6
pubmed: 22020563
Ann Surg. 2019 Jun;269(6):1041-1053
pubmed: 31082900
J Am Coll Surg. 2017 Nov;225(5):666-675.e2
pubmed: 28838870