Department of Surgery, The Ohio State University Wexner Medical Center and The James Comprehensive Cancer Center, Columbus, Ohio, United States; Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland.
Department of Surgery, The Ohio State University Wexner Medical Center and The James Comprehensive Cancer Center, Columbus, Ohio, United States.
J Gastrointest Surg. 2024 Jan;28(1):10-17. doi: 10.1016/j.gassur.2023.11.017.
Although receipt of neoadjuvant chemotherapy has been identified to improve unfavorable survival outcomes among patients with locally advanced gastric cancer (LAGC), several randomized controlled trials have not demonstrated a difference in oncological outcomes/overall survival (OS) among patients undergoing minimally invasive surgery (MIS) versus open gastrectomy. This study aimed to investigate National Comprehensive Cancer Network (NCCN) guideline adherence and textbook oncological outcome (TOO) among patients undergoing MIS versus open surgery for LAGC.
In this cross-sectional study, patients with stage II/III LAGC (cT2-T4N0-3M0) who underwent curative-intent treatment between 2013 and 2019 were evaluated using the National Cancer Database. Multivariable analysis was performed to assess the association between surgical approach, NCCN guideline adherence, TOO, and OS. The study was registered on the International Standard Randomised Controlled Trial Number registry (registration number: ISRCTN53410429) and conducted according to the Strengthening The Reporting Of Cohort Studies in Surgery and Strengthening the Reporting of Observational Studies in Epidemiology guidelines.
Among 13,885 patients, median age at diagnosis was 68 years (IQR, 59-76); most patients were male (n = 9887, 71.2%) and identified as White (n = 10,295, 74.1%). Patients who underwent MIS (n = 4692, 33.8%) had improved NCCN guideline adherence and TOO compared with patients who underwent open surgery (51.3% vs 43.5% and 36.7% vs 27.3%, respectively; both P < .001). Adherence to NCCN guidelines and likelihood to achieve TOO increased from 2013 to 2019 (35.6% vs 50.9% and 31.4% vs 46.4%, respectively; both P < .001). Moreover, improved median OS was observed among patients with NCCN guideline adherence and TOO undergoing MIS versus open surgery (57.3 vs 49.8 months [P = .041] and 68.4 vs 60.6 months [P = .025], respectively).
An overall increase in guideline-adherent treatment and achievement of TOO among patients with LAGC undergoing multimodal and curative-intent treatment in the United States was observed. Adoption of minimally invasive gastrectomy may result in improved short- and long-term outcomes.
尽管新辅助化疗的应用已被证实可改善局部进展期胃癌（LAGC）患者的不良生存结局，但几项随机对照试验并未显示微创外科（MIS）与开腹胃切除术治疗 LAGC 患者的肿瘤学结局/总生存期（OS）存在差异。本研究旨在探讨接受 MIS 与开腹手术治疗 LAGC 患者的美国国家综合癌症网络（NCCN）指南依从性和教科书肿瘤学结局（TOO）。
在这项横断面研究中，评估了 2013 年至 2019 年间接受根治性治疗的 II/III 期 LAGC（cT2-T4N0-3M0）患者的国家癌症数据库。采用多变量分析评估手术方式、NCCN 指南依从性、TOO 和 OS 之间的关联。该研究在国际标准随机对照试验登记处（登记号：ISRCTN53410429）进行了注册，并根据强化外科队列研究报告标准和强化观察性研究在流行病学中的报告标准进行了报告。
在 13885 例患者中，中位诊断年龄为 68 岁（IQR，59-76）；大多数患者为男性（n=9887，71.2%），且为白人（n=10295，74.1%）。与接受开腹手术的患者相比（分别为 51.3% vs 43.5%和 36.7% vs 27.3%，均 P<.001），接受 MIS 的患者的 NCCN 指南依从性和 TOO 更高。2013 年至 2019 年，NCCN 指南的依从性和实现 TOO 的可能性增加（分别为 35.6% vs 50.9%和 31.4% vs 46.4%，均 P<.001）。此外，在接受 MIS 治疗的 NCCN 指南依从性和 TOO 的患者中，观察到中位 OS 得到改善（分别为 57.3 个月 vs 49.8 个月[P=.041]和 68.4 个月 vs 60.6 个月[P=.025]）。
在美国，接受多模式和根治性治疗的 LAGC 患者的指南依从性治疗和实现 TOO 的总体比例有所增加。采用微创胃切除术可能会带来短期和长期结局的改善。
