Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, AB, Canada.
Am J Clin Oncol. 2021 Apr 1;44(4):158-161. doi: 10.1097/COC.0000000000000799.
The objective of this study was to review real-world patterns of chemotherapy utilization among patients with metastatic gastric/lower esophageal adenocarcinoma with particular focus on the use of ramucirumab plus paclitaxel in previously treated patients.
This is a retrospective, registry-based study using datasets from Alberta Cancer Registry and other provincial databases in Alberta, Canada. Multivariable logistic regression analysis was used to identify factors associated with palliative chemotherapy use. Among patients who received >1 line of chemotherapy, Kaplan-Meier survival estimates were used to compare outcomes according to ramucirumab plus paclitaxel use. Multivariable Cox regression analysis was then used to identify factors associated with overall survival (OS) in this cohort.
A total of 1590 patients were included (including 1070 gastric patients and 520 lower esophageal patients). The following factors were associated with use of palliative chemotherapy: younger age (odds ratio with increasing age: 0.95; 95% confidence interval [CI]: 0.94-0.95), and lower Charlson Comorbidity Index (odds ratio with increasing index: 0.82; 95% CI: 0.74-0.91). Within the subcohort of patients who received >1 line of chemotherapy, use of ramucirumab/paclitaxel was associated with better OS (P=0.033). Multivariable Cox regression analysis suggested that the following factors are associated with better OS: use of ramucirumab/paclitaxel (hazard ratio [HR]: 1.56; 95% CI: 1.07-2.29) and living within urban zones including Calgary or Edmonton zones (vs. Northern zone) (HR for Calgary zone vs. Northern zone: 0.44; 95% CI: 0.23-0.85; HR for Edmonton zone vs. Northern zone: 0.41; 95% CI: 0.22-0.77).
Use of paclitaxel/ramucirumab combination beyond first-line treatment is associated with improved OS among patients with metastatic gastric/lower esophageal adenocarcinoma in this real-world study. Further work is needed to reduce disparity in our health care system between individuals living in rural versus urban areas.
本研究旨在回顾转移性胃/下食管腺癌患者化疗应用的真实世界模式，特别关注在既往治疗患者中应用雷莫芦单抗联合紫杉醇。
这是一项基于阿尔伯塔癌症登记处和加拿大阿尔伯塔省其他省级数据库的回顾性登记研究。多变量逻辑回归分析用于确定与姑息化疗应用相关的因素。在接受>1 线化疗的患者中，使用 Kaplan-Meier 生存估计来比较根据雷莫芦单抗联合紫杉醇使用的结果。然后使用多变量 Cox 回归分析来确定该队列中与总生存期（OS）相关的因素。
共纳入 1590 例患者（包括 1070 例胃患者和 520 例下食管患者）。以下因素与姑息化疗的应用相关：年龄较小（年龄增加的比值比：0.95；95%置信区间[CI]：0.94-0.95）和较低的 Charlson 合并症指数（指数增加的比值比：0.82；95%CI：0.74-0.91）。在接受>1 线化疗的亚组患者中，雷莫芦单抗/紫杉醇的应用与更好的 OS 相关（P=0.033）。多变量 Cox 回归分析表明，以下因素与更好的 OS 相关：雷莫芦单抗/紫杉醇的应用（风险比[HR]：1.56；95%CI：1.07-2.29）和居住在卡尔加里或埃德蒙顿区等市区（与北部区相比）（卡尔加里区与北部区的 HR：0.44；95%CI：0.23-0.85；埃德蒙顿区与北部区的 HR：0.41；95%CI：0.22-0.77）。
在这项真实世界研究中，转移性胃/下食管腺癌患者在一线治疗以外应用紫杉醇/雷莫芦单抗联合治疗与 OS 改善相关。需要进一步努力减少我们的医疗保健系统中农村与城市地区个体之间的差异。
