Comparative effectiveness of treatment modalities in non-metastatic gastric adenocarcinoma: a propensity score matching analysis of the National Cancer Database
Background While addition of chemotherapy and radiation to surgery improves the outcomes of non-metastatic gastric adenocarcinoma (GAC), the best treatment strategy remains controversial.Methods To determine the effectiveness of different strategies in patients with curative surgery, we performed an...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2020-12-01
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| Series: | BMJ Open Gastroenterology |
| Online Access: | https://bmjopengastro.bmj.com/content/7/1/e000483.full |
| _version_ | 1826933042488279040 |
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| author | Manish A Shah Afsaneh Barzi Dongyun Yang Anthony W Kim Sarmad Sadeghi |
| author_facet | Manish A Shah Afsaneh Barzi Dongyun Yang Anthony W Kim Sarmad Sadeghi |
| author_sort | Manish A Shah |
| collection | DOAJ |
| description | Background While addition of chemotherapy and radiation to surgery improves the outcomes of non-metastatic gastric adenocarcinoma (GAC), the best treatment strategy remains controversial.Methods To determine the effectiveness of different strategies in patients with curative surgery, we performed an analysis of GAC patients in National Cancer Database. Propensity score method was used to control for imbalances in the confounders. Overall survival (OS), the primary outcome, was analysed using Cox proportional hazard model and Kaplan-Meier curves.Results Patients diagnosed with GAC, from 2004 to 2013, were included in this analysis and grouped according to their treatment: surgery alone (15 184), chemoradiation in the neoadjuvant (6000) or adjuvant setting (7953), and perioperative chemotherapy (PCh; 3745) or adjuvant chemotherapy (ACh; 3000). Compared with surgery alone, all adjunctive therapies resulted in an improvement in OS; neoadjuvant chemoradiation (NACRT): HR 0.9 (95% CI: 0.84 to 0.97), PCh: HR 0.73 (95% CI: 0.68 to 0.79), adjuvant chemoradiation (ACRT): HR 0.71 (95% CI: 0.67 to 0.75), and ACh: HR 0.86 (95% CI: 0.8 to 0.93). Excluding patients with surgery only, we compared different strategies to PCh. In patients with distal GAC, ACRT resulted in improved OS, (HR 0.89; 95% CI: 0.796 to 0.996), p=0.042. In patients with proximal GAC, NACRT was inferior to PCh, HR 1.101 (95% CI: 1.006 to 1.204), p=0.036.Conclusion In this real world population, addition of chemotherapy and radiation to surgery was associated with better OS. Radiation therapy may have a role in patients with distal GAC. Future research can elucidate patient, tumour, and treatment factors that necessitate the inclusion and sequence of radiation therapy in this population. |
| first_indexed | 2024-12-14T01:03:28Z |
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| id | doaj.art-04524de20dfa437a9e6cfd4db0c8452a |
| institution | Directory Open Access Journal |
| issn | 2054-4774 |
| language | English |
| last_indexed | 2025-02-17T17:25:28Z |
| publishDate | 2020-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Gastroenterology |
| spelling | doaj.art-04524de20dfa437a9e6cfd4db0c8452a2024-12-14T20:40:09ZengBMJ Publishing GroupBMJ Open Gastroenterology2054-47742020-12-017110.1136/bmjgast-2020-000483Comparative effectiveness of treatment modalities in non-metastatic gastric adenocarcinoma: a propensity score matching analysis of the National Cancer DatabaseManish A Shah0Afsaneh Barzi1Dongyun Yang2Anthony W Kim3Sarmad Sadeghi417 Department of Medicine, Weill Cornell Medicine, New York, New York, USADepartment of Medical Oncology and Therapeutics, City of Hope Comprehensive Cancer Center, Duarte, California, USADivision of Biostatistics, City of Hope Comprehensive Cancer Center, Duarte, California, USADivision of Thoracic Surgery, USC-Keck School of Medicine, Los Angeles, California, USADepartment of Medicine, USC-Norris Comprehensive Cancer Center, Los Angeles, California, USABackground While addition of chemotherapy and radiation to surgery improves the outcomes of non-metastatic gastric adenocarcinoma (GAC), the best treatment strategy remains controversial.Methods To determine the effectiveness of different strategies in patients with curative surgery, we performed an analysis of GAC patients in National Cancer Database. Propensity score method was used to control for imbalances in the confounders. Overall survival (OS), the primary outcome, was analysed using Cox proportional hazard model and Kaplan-Meier curves.Results Patients diagnosed with GAC, from 2004 to 2013, were included in this analysis and grouped according to their treatment: surgery alone (15 184), chemoradiation in the neoadjuvant (6000) or adjuvant setting (7953), and perioperative chemotherapy (PCh; 3745) or adjuvant chemotherapy (ACh; 3000). Compared with surgery alone, all adjunctive therapies resulted in an improvement in OS; neoadjuvant chemoradiation (NACRT): HR 0.9 (95% CI: 0.84 to 0.97), PCh: HR 0.73 (95% CI: 0.68 to 0.79), adjuvant chemoradiation (ACRT): HR 0.71 (95% CI: 0.67 to 0.75), and ACh: HR 0.86 (95% CI: 0.8 to 0.93). Excluding patients with surgery only, we compared different strategies to PCh. In patients with distal GAC, ACRT resulted in improved OS, (HR 0.89; 95% CI: 0.796 to 0.996), p=0.042. In patients with proximal GAC, NACRT was inferior to PCh, HR 1.101 (95% CI: 1.006 to 1.204), p=0.036.Conclusion In this real world population, addition of chemotherapy and radiation to surgery was associated with better OS. Radiation therapy may have a role in patients with distal GAC. Future research can elucidate patient, tumour, and treatment factors that necessitate the inclusion and sequence of radiation therapy in this population.https://bmjopengastro.bmj.com/content/7/1/e000483.full |
| spellingShingle | Manish A Shah Afsaneh Barzi Dongyun Yang Anthony W Kim Sarmad Sadeghi Comparative effectiveness of treatment modalities in non-metastatic gastric adenocarcinoma: a propensity score matching analysis of the National Cancer Database BMJ Open Gastroenterology |
| title | Comparative effectiveness of treatment modalities in non-metastatic gastric adenocarcinoma: a propensity score matching analysis of the National Cancer Database |
| title_full | Comparative effectiveness of treatment modalities in non-metastatic gastric adenocarcinoma: a propensity score matching analysis of the National Cancer Database |
| title_fullStr | Comparative effectiveness of treatment modalities in non-metastatic gastric adenocarcinoma: a propensity score matching analysis of the National Cancer Database |
| title_full_unstemmed | Comparative effectiveness of treatment modalities in non-metastatic gastric adenocarcinoma: a propensity score matching analysis of the National Cancer Database |
| title_short | Comparative effectiveness of treatment modalities in non-metastatic gastric adenocarcinoma: a propensity score matching analysis of the National Cancer Database |
| title_sort | comparative effectiveness of treatment modalities in non metastatic gastric adenocarcinoma a propensity score matching analysis of the national cancer database |
| url | https://bmjopengastro.bmj.com/content/7/1/e000483.full |
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