Trip Anouk K, Stiekema Jurriën, Visser Otto, Dikken Johan L, Cats Annemieke, Boot Henk, van Sandick Johanna W, Jansen Edwin P M, Verheij Marcel
a Department of Radiation Oncology , The Netherlands Cancer Institute , Amsterdam , The Netherlands.
b Department of Surgery The Netherlands Cancer Institute , Amsterdam , The Netherlands.
Acta Oncol. 2015 Nov;54(10):1754-62. doi: 10.3109/0284186X.2015.1009638. Epub 2015 Mar 23.
In recent years, evidence supporting multimodality treatment for oesophageal, oesophagogastric junction (OGJ), and gastric cancer has accumulated. This population-based cohort-study investigates trends and predictors of utilisation of multimodality treatment for oesophagogastric cancer in the Netherlands.
Data were obtained from the Netherlands Cancer Registry regarding patients with oesophageal (n = 5450), OGJ (n = 2168) and gastric cancer (n = 6683) without distant metastases who had undergone R0 or R1 surgery diagnosed between 2000 and 2012. Follow-up was completed until February 2014. Preoperative/postoperative chemotherapy and/or radiotherapy combined with surgery were considered multimodality treatment. Logistic regression analysis was performed to analyse the association of age, gender, socioeconomic status, clinical T and N classification, hospital type, comprehensive cancer centre network region, and year of diagnosis, with multimodality treatment receipt. Additional analyses were performed to explore differences in trends of utilisation of multimodality treatment between academic and non-academic hospitals.
Multimodality treatment utilisation for oesophageal, OGJ and gastric cancer increased significantly to 90%, 85% and 56% in 2012, respectively. In oesophageal and OGJ cancer patients, preoperative chemoradiotherapy was most frequently administered (85% and 47% in 2012, respectively), and in gastric cancer patients preoperative chemotherapy (47% in 2012). Lower age, higher clinical T and N classification, and diagnosis in more recent years were significantly associated with more frequent multimodality treatment receipt. The adoption of most types of multimodality treatment in academic hospitals preceded non-academic hospitals by a year.
In the Netherlands, the utilisation of multimodality treatment for oesophagogastric cancer has significantly increased during the past decade, especially in oesophageal and OGJ cancer. Multimodality treatment utilisation was especially dependent on patient and tumour characteristics and year of diagnosis, but multimodality treatment trends seem to be related to the publication of landmark studies, participation in nationally running clinical trials, and hospital type, preceding national guidelines.
近年来，支持对食管癌、食管胃交界部（OGJ）癌和胃癌进行多模式治疗的证据不断积累。这项基于人群的队列研究调查了荷兰食管胃癌多模式治疗的使用趋势和预测因素。
从荷兰癌症登记处获取了2000年至2012年间接受R0或R1手术且无远处转移的食管癌患者（n = 5450）、OGJ癌患者（n = 2168）和胃癌患者（n = 6683）的数据。随访至2014年2月结束。术前/术后化疗和/或放疗联合手术被视为多模式治疗。进行逻辑回归分析以分析年龄、性别、社会经济地位、临床T和N分类、医院类型、综合癌症中心网络区域以及诊断年份与接受多模式治疗之间的关联。还进行了额外分析以探讨学术医院和非学术医院在多模式治疗使用趋势上的差异。
2012年，食管癌、OGJ癌和胃癌的多模式治疗使用率分别显著提高到90%、85%和56%。在食管癌和OGJ癌患者中，术前放化疗最为常用（2012年分别为85%和47%），而在胃癌患者中术前化疗最为常用（2012年为47%）。年龄较小、临床T和N分类较高以及近年诊断与更频繁接受多模式治疗显著相关。学术医院对大多数类型多模式治疗的采用比非学术医院早一年。
在荷兰，过去十年中食管胃癌多模式治疗的使用率显著提高，尤其是在食管癌和OGJ癌方面。多模式治疗的使用尤其取决于患者和肿瘤特征以及诊断年份，但多模式治疗趋势似乎与具有里程碑意义的研究的发表、参与全国性临床试验以及医院类型有关，早于国家指南。
