Cincinnati Research on Outcomes and Safety in Surgery (CROSS), Cincinnati, OH, USA.
Department of Surgery, University of Cincinnati College of Medicine, 231 Albert Sabin Way ML 0558, Cincinnati, OH, 45267, USA.
J Gastrointest Surg. 2021 Jan;25(1):36-47. doi: 10.1007/s11605-020-04868-0. Epub 2020 Nov 17.
Level 1 evidence for multimodal treatment of resectable gastric adenocarcinoma from the Intergroup 0116 (2001) and MAGIC (2006) trials demonstrated survival benefit of adjuvant chemoradiation (CRT) and perioperative chemotherapy, respectively. We evaluated the adoption of evidence-based treatment in the post-MAGIC era and its impact on survival.
A total of 7058 patients with resectable gastric adenocarcinoma undergoing definitive surgical resection between 2004 and 2015 were analyzed using the National Cancer Database.
Over the study period, the proportion of patients receiving adjuvant CRT decreased from 19.1% to 9.1%, while perioperative chemotherapy increased from 1.9% to 28.6%. Utilization of perioperative chemotherapy surpassed adjuvant CRT in 2011. Evidence-based treatment (either perioperative chemotherapy or adjuvant CRT) had better overall survival (OS) than other treatments for clinical stage II-III patients (p < 0.05). On multivariate analysis of the whole study period, evidence-based treatments were associated with better OS (HR 0.67 [0.60-0.74], p < 0.05). Only 360/1262 (28.5%) patients in the perioperative chemotherapy group completed postoperative therapy, which was associated with improved OS (p < 0.05). For clinical stage III patients (n = 2402), only 806 (33.6%) received evidence-based treatment, while 487 (22.2%) underwent surgery alone. On multivariate analysis of these patients between 2010 and 2015, both perioperative chemotherapy (HR 0.49 [0.35-0.68]) and adjuvant CRT (HR 0.31 [0.21-0.44]) were associated with better OS than surgery alone (p < 0.05).
Since the INT-0116 and MAGIC trials, utilization of evidence-based treatments for resectable gastric adenocarcinoma has increased, with perioperative chemotherapy surpassing adjuvant CRT as the preferred practice. However, overall utilization of these regimens remains quite low nationally despite association with improved OS.
来自于 0116 国际协作组（2001 年）和 MAGIC 试验（2006 年）的 1 级证据表明，可切除胃腺癌患者接受辅助放化疗（CRT）和围手术期化疗可分别获得生存获益。我们评估了 MAGIC 试验后采用循证治疗的情况及其对生存的影响。
我们使用国家癌症数据库分析了 2004 年至 2015 年间进行根治性手术的 7058 例可切除胃腺癌患者。
在研究期间，接受辅助 CRT 的患者比例从 19.1%降至 9.1%，而围手术期化疗的比例从 1.9%增至 28.6%。2011 年，围手术期化疗的使用率超过了辅助 CRT。对于临床 II-III 期患者，接受循证治疗（围手术期化疗或辅助 CRT）的总生存（OS）优于其他治疗（p < 0.05）。在整个研究期间的多变量分析中，循证治疗与更好的 OS 相关（HR 0.67[0.60-0.74]，p < 0.05）。接受围手术期化疗的 1262 例患者中仅有 360 例（28.5%）完成了术后治疗，这与改善 OS 相关（p < 0.05）。对于临床 III 期患者（n = 2402），仅有 806 例（33.6%）接受了循证治疗，而 487 例（22.2%）仅接受了手术治疗。在这些患者 2010 年至 2015 年的多变量分析中，围手术期化疗（HR 0.49[0.35-0.68]）和辅助 CRT（HR 0.31[0.21-0.44]）与单独手术相比均与更好的 OS 相关（p < 0.05）。
自 0116 国际协作组和 MAGIC 试验以来，可切除胃腺癌患者接受循证治疗的比例有所增加，围手术期化疗已超过辅助 CRT 成为首选治疗方法。然而，尽管这些方案与改善 OS 相关，但全国范围内的总体使用率仍然相当低。
