Department of Surgery, Queen's University, Kingston, Ontario, Canada.
Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada.
JCO Oncol Pract. 2021 Oct;17(10):e1537-e1550. doi: 10.1200/OP.20.00397. Epub 2021 Jan 15.
Clinical trials have shown that palliative chemotherapy (PC) improves survival in patients with incurable esophageal and gastric cancer; however, outcomes achieved in routine practice are unknown. We describe treatment patterns and outcomes among patients treated in the general population of Ontario, Canada.
The Ontario Cancer Registry was used to identify patients with esophageal or gastric cancer from 2007 to 2016, and data were linked to other health administrative databases. Patients who received curative-intent surgery or radiotherapy were excluded. Factors associated with the receipt of PC were determined using logistic regression. First-line PC regimens were categorized, and trends over time were reported. Survival was determined using the Kaplan-Meier method.
The cohort included 9,848 patients; 22% (2,207 of 9,848) received PC. Patients receiving PC were younger (mean age, 63 74 years; < .0001) and more likely male (71% 65%; < .0001). Thirty-seven percent of non-PC patients saw a medical oncologist in consultation. Over the study period, utilization of PC increased (from 11% in 2007 to 19% in 2016; < .0001), whereas the proportion of patients receiving triplet regimens decreased (65% in 2007 to 56% in 2016; = .04). In the PC group, the median overall and cancer-specific survival from treatment initiation was 7.2 months.
One fifth of patients with incurable esophageal and gastric cancer in the general population receive PC. Median survival of patients treated in routine practice is inferior to that in clinical trials. Only one third of patients not treated with PC had consultation with a medical oncologist. Further work is necessary to understand low utilization of PC and medical oncology consultation in this patient population.
临床试验表明姑息化疗（PC）可提高无法治愈的食管和胃癌患者的生存率；然而，常规实践中的结果尚不清楚。我们描述了在加拿大安大略省普通人群中接受治疗的患者的治疗模式和结果。
利用安大略癌症登记处从 2007 年至 2016 年确定患有食管或胃癌的患者，并将数据与其他健康管理数据库相链接。排除接受根治性手术或放疗的患者。使用逻辑回归确定接受 PC 的相关因素。对一线 PC 方案进行分类，并报告随时间的变化趋势。使用 Kaplan-Meier 法确定生存率。
该队列包括 9848 例患者；22%（2207/9848）接受了 PC。接受 PC 的患者年龄较小（平均年龄 63 74 岁；<0.0001）且更可能为男性（71%65%；<0.0001）。37%的非 PC 患者接受了医学肿瘤学家的咨询。在研究期间，PC 的使用率增加（从 2007 年的 11%增加到 2016 年的 19%；<0.0001），而接受三联方案的患者比例下降（2007 年的 65%下降到 2016 年的 56%；=0.04）。在 PC 组中，从治疗开始到整体和癌症特异性生存的中位数为 7.2 个月。
在普通人群中，20%的无法治愈的食管和胃癌患者接受 PC 治疗。常规实践中治疗患者的中位生存时间劣于临床试验中的生存时间。未接受 PC 治疗的患者中，只有三分之一接受了医学肿瘤学家的咨询。需要进一步努力了解该患者群体中 PC 和医学肿瘤学咨询的低利用率。
