Department of Surgery, College of Medicine, The Pennsylvania State University, Hershey, PA 17036, USA.
Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA 17036, USA.
Curr Oncol. 2020 Dec 24;28(1):138-151. doi: 10.3390/curroncol28010017.
Gastric cancer is the third most common cause of cancer deaths worldwide. Despite evidence-based recommendation for treatment, the current treatment patterns for all stages of gastric cancer remain largely unexplored. This study investigates trends in the treatments and survival of gastric cancer. The National Cancer Database was used to identify gastric adenocarcinoma patients from 2004-2016. Chi-square tests were used to examine subgroup differences between disease stages: Stage I, II/III and IV. Multivariate analyses identified factors associated with the receipt of guideline concordant care. The Kaplan-Meier method was used to assess three-year overall survival. The final cohort included 108,150 patients: 23,584 Stage I, 40,216 Stage II/III, and 44,350 Stage IV. Stage specific guideline concordant care was received in only 73% of patients with Stage I disease and 51% of patients with Stage II/III disease. Patients who received guideline consistent care had significantly improved survival compared to those who did not. Overall, we found only moderate improvement in guideline adherence and three-year overall survival during the 13-year study time period. This study showed underutilization of stage specific guideline concordant care for stage I and II/III disease.
胃癌是全球癌症死亡的第三大主要原因。尽管有基于证据的治疗建议，但胃癌各期的当前治疗模式仍在很大程度上未被探索。本研究调查了胃癌治疗和生存的趋势。国家癌症数据库用于确定 2004 年至 2016 年间的胃腺癌患者。卡方检验用于检查疾病分期之间的亚组差异：I 期、II/III 期和 IV 期。多变量分析确定了与接受指南一致治疗相关的因素。Kaplan-Meier 法用于评估三年总体生存率。最终队列包括 108150 名患者：I 期 23584 例，II/III 期 40216 例，IV 期 44350 例。仅 73%的 I 期疾病患者和 51%的 II/III 期疾病患者接受了特定阶段的指南一致治疗。与未接受指南一致治疗的患者相比，接受指南一致治疗的患者的生存显著改善。总体而言，在 13 年的研究期间，我们仅发现指南依从性和三年总体生存率有适度提高。本研究表明，I 期和 II/III 期疾病对特定阶段指南一致治疗的利用率不足。
