Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
University of Missouri School of Medicine, Columbia, Missouri.
Cancer. 2018 Mar 15;124(6):1122-1131. doi: 10.1002/cncr.31179. Epub 2017 Dec 6.
The adoption of novel and effective gastric cancer therapies into general clinical practice has crucial implications for patient outcomes. The current study explored trends in treatment use and overall survival in patients with gastric cancer in the United States.
Patients with adenocarcinoma of the gastric cardia and noncardia were identified in the National Cancer Data Base between 2006 and 2014. Tumor stages were divided into early (IA), locally advanced (IB-IIIC), and metastatic (IV) stage. Treatment use was examined according to tumor stage and location. Time trend analyses of treatment use and overall survival were conducted.
A total of 89,098 patients with gastric adenocarcinoma were identified. In those with early-stage cancer, endoscopic treatment increased over time in patients with cardia and noncardia disease. In patients with locally advanced cardia disease, preoperative therapy use increased over time (2013-2014 [vs 2006-2008]: odds ratio [OR], 3.09; 95% confidence interval [95% CI], 2.80-3.41). In patients with locally advanced noncardia disease, the use of preoperative therapy also increased (2013-2014: OR, 3.32; 95% CI, 2.88-3.82) as did the use of perioperative therapy (2013-2014: OR, 4.21; 95% CI, 3.52-5.03) in lieu of postoperative treatment (2013-2014: OR, 0.66; 95% CI, 0.60-0.71). In patients with metastatic disease, approximately 34% of patients with cardia and 40% of patients with noncardia cancer did not receive treatment. Stage-specific and location-specific overall survival was found to improve over the study period.
Practice patterns for the treatment of gastric cancer in the United States reflect the increased adoption of evidence-based therapies, including endoscopic resection of early-stage cancer and preoperative therapy for patients with locally advanced disease. Treatment for metastatic disease remains markedly underused. Cancer 2018;124:1122-31. © 2017 American Cancer Society.
新型有效胃癌疗法在临床实践中的应用对患者的预后具有重要意义。本研究探讨了美国胃癌患者的治疗应用和总体生存率的趋势。
从国家癌症数据库中确定了 2006 年至 2014 年间患有贲门和非贲门腺癌的患者。肿瘤分期分为早期（IA）、局部晚期（IB-IIIC）和转移性（IV）期。根据肿瘤分期和位置检查治疗的应用。对治疗应用和总体生存率进行时间趋势分析。
共确定了 89098 例胃癌患者。在早期癌症患者中，贲门和非贲门疾病患者的内镜治疗随着时间的推移而增加。局部晚期贲门疾病患者的术前治疗使用率随着时间的推移而增加（2013-2014 年[与 2006-2008 年相比]：比值比[OR]，3.09；95%置信区间[95%CI]，2.80-3.41）。局部晚期非贲门疾病患者的术前治疗使用率也有所增加（2013-2014 年：OR，3.32；95%CI，2.88-3.82），围手术期治疗（2013-2014 年：OR，4.21；95%CI，3.52-5.03）的使用率也有所增加，而术后治疗（2013-2014 年：OR，0.66；95%CI，0.60-0.71）的使用率有所下降。转移性疾病患者中，约 34%的贲门癌患者和 40%的非贲门癌患者未接受治疗。研究期间发现，特定分期和特定部位的总体生存率有所提高。
美国胃癌治疗模式反映了证据为基础的治疗方法的应用增加，包括早期癌症的内镜切除术和局部晚期疾病患者的术前治疗。转移性疾病的治疗仍然明显不足。癌症 2018；124：1122-31。©2017 年美国癌症协会。
