Coburn Natalie G, Guller Ulrich, Baxter Nancy N, Kiss Alex, Ringash Jolie, Swallow Carol J, Law Calvin H L
Department of Surgery, University of Toronto, Toronto, ON, Canada.
Int J Radiat Oncol Biol Phys. 2008 Mar 15;70(4):1073-80. doi: 10.1016/j.ijrobp.2007.07.2378. Epub 2007 Oct 1.
The Southwest Oncology Group/Intergroup 0116 (INT-0116) trial showed that adjuvant chemoradiotherapy improves survival in high-risk gastric adenocarcinoma patients. This study examined the adoption of adjuvant treatment following the trial results and the factors associated with its use.
Between 1996 and 2003, patients aged 18-85 years with resected gastric adenocarcinoma were identified in the Surveillance, Epidemiology, and End Results (SEER) database and classified as diagnosed before (January 1996 to April 2000) or after (May 2000 to December 2003) presentation of the INT-0116 trial findings. Univariate and multivariable models were used to determine the factors associated with use of adjuvant radiotherapy (RT).
Of 10,230 patients studied, 14.6% were given adjuvant RT before the INT-0116 trial, increasing to 30.4% afterward (p<0.001). Significant increases in adjuvant RT from before to after INT-0116 were seen in all demographic categories. Younger patients were significantly more likely to receive adjuvant RT (44.5%, 18-59 years; 31.0%, 60-74 years; and 12.6%, 75-85 years, p<0.0001). Married patients were significantly more likely to receive adjuvant RT (30.9%) than were unmarried patients (23.6%, p<0.001). A greater depth of tumor invasion, worse nodal status, and more lymph nodes assessed were associated with adjuvant RT (p<0.0001). The rate of adjuvant RT varied from 22.9-44.2% across SEER regions. On multiple logistic regression analysis, age, SEER region, marital status, assessed lymph nodes, tumor depth, and nodal status were all significant independent predictors of the use of adjuvant RT.
Use of adjuvant RT doubled after the INT-0116 trial results became public; however, the fraction of patients receiving adjuvant RT is still low. Additional examination of the statistically significant and clinically relevant variability between different SEER regions, tumor characteristics, and patient demographics is warranted.
西南肿瘤协作组/国际协作组0116（INT - 0116）试验表明，辅助放化疗可提高高危胃腺癌患者的生存率。本研究探讨了该试验结果公布后辅助治疗的采用情况及其相关因素。
1996年至2003年间，在监测、流行病学和最终结果（SEER）数据库中识别出年龄在18 - 85岁、胃腺癌已切除的患者，并根据INT - 0116试验结果公布时间分为试验结果公布前（1996年1月至2000年4月）和公布后（2000年5月至2003年12月）两组。采用单因素和多因素模型确定与辅助放疗（RT）使用相关的因素。
在研究的10230例患者中，INT - 0116试验前14.6%的患者接受了辅助放疗，试验后这一比例增至30.4%（p<0.001）。在所有人口统计学类别中，INT - 0116试验前后辅助放疗的使用均显著增加。年轻患者接受辅助放疗的可能性显著更高（18 - 59岁为44.5%；60 - 74岁为31.0%；75 - 85岁为12.6%，p<0.0001）。已婚患者接受辅助放疗的可能性显著高于未婚患者（30.9%对23.6%，p<0.001）。肿瘤侵犯深度越深、淋巴结状态越差以及评估的淋巴结越多，与辅助放疗相关（p<0.0001）。SEER各地区辅助放疗的使用率在22.9%至44.2%之间。多因素逻辑回归分析显示，年龄、SEER地区、婚姻状况、评估的淋巴结、肿瘤深度和淋巴结状态均是辅助放疗使用的显著独立预测因素。
INT - 0116试验结果公布后，辅助放疗的使用增加了一倍；然而，接受辅助放疗的患者比例仍然较低。有必要进一步研究不同SEER地区、肿瘤特征和患者人口统计学之间在统计学上显著且临床相关的差异。
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