荷兰可切除胃癌患者接受氟尿嘧啶、亚叶酸钙、奥沙利铂和多西他赛围手术期化疗的情况。

Patient access to perioperative chemotherapy with fluorouracil, leucovorin, oxaliplatin and docetaxel in patients with resectable gastric cancer in the Netherlands.

作者信息

Geerts Julie F M, Pape Marieke, Vissers Pauline A J, Verhoeven Rob H A, Mostert Bianca, Wijnhoven Bas P L, Rosman Camiel, van Hellemond Irene E G, Nieuwenhuijzen Grard A P, van Laarhoven Hanneke W M

机构信息

Department of Surgery, Catharina Ziekenhuis Eindhoven, Michelangelolaan 2, 5623 EJ Eindhoven, Netherlands.

Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT Utrecht, Netherlands; Amsterdam UMC location University of Amsterdam, Medical Oncology, Meibergdreef 9, Amsterdam, Netherlands; Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, Netherlands.

出版信息

Eur J Cancer. 2025 Jan;214:115137. doi: 10.1016/j.ejca.2024.115137. Epub 2024 Nov 20.

DOI:10.1016/j.ejca.2024.115137

PMID:39591847

Abstract

BACKGROUND

The FLOT4 trial demonstrated superior survival of perioperative chemotherapy with 5-fluorouracil, oxaliplatin, and docetaxel (FLOT) compared to anthracycline triplets for resectable gastric cancer. These results were presented at the American Society of Clinical Oncology (ASCO) congress in June 2017 and published in April 2019. However, adoption of novel treatments in clinical practice often encounters delays. This study assesses the patterns of perioperative chemotherapy utilization and FLOT uptake in clinical practice within the Netherlands.

MATERIALS AND METHODS

A retrospective cohort study was conducted with resectable gastric cancer patients (cTcNcM) between 2015-2020 from the Netherlands Cancer Registry. Descriptive statistics, Cochran-Armitage tests, Fisher's exact or unpaired T-tests, and Jonckheere-Terpstra tests were used to analyze chemotherapy trends and FLOT uptake across hospitals.

RESULTS

Among 3290 included patients, 42.9 % received neoadjuvant treatment. In 2015, 43.6 % of patients received perioperative chemotherapy versus 43.5 % in 2020 (p = 0.63). 40 out of 62 hospitals (64.5 %) adopted FLOT between the ASCO presentation and the full publication. FLOT increased from 42.9 % before publication to 86.8 % after publication (p < 0.0001), while anthracycline triplet use decreased to 0.9 % (p < 0.0001). Higher hospital volume was associated with fewer days to adoption (p = 0.04) but not with adoption of FLOT before publication (p = 0.14).

CONCLUSION

Timing of FLOT adoption varied among Dutch hospitals, leading to unequal patient access to effective treatments. Establishing (inter)national guidelines on provisional treatment adjustment pending publication is crucial to reduce variation in access. Moreover, rapid publication of final trial results is imperative to reduce variation in practice and ensure fair patient treatment.

摘要

背景

FLOT4试验表明，对于可切除的胃癌，与蒽环类三联疗法相比，围手术期使用氟尿嘧啶、奥沙利铂和多西他赛（FLOT）进行化疗可提高生存率。这些结果于2017年6月在美国临床肿瘤学会（ASCO）大会上公布，并于2019年4月发表。然而，新疗法在临床实践中的应用往往会出现延迟。本研究评估了荷兰临床实践中围手术期化疗的使用模式以及FLOT的采用情况。

材料与方法

对荷兰癌症登记处2015年至2020年期间的可切除胃癌患者（cTcNcM）进行了一项回顾性队列研究。使用描述性统计、 Cochr an-Armitage检验、Fisher精确检验或非配对T检验以及Jonckheere-Terpstra检验来分析各医院的化疗趋势和FLOT采用情况。

结果

在纳入的3290例患者中，42.9%接受了新辅助治疗。2015年，43.6%的患者接受了围手术期化疗，2020年这一比例为43.5%（p = 0.63）。在ASCO公布结果至完整发表期间，62家医院中有40家（64.5%）采用了FLOT。FLOT的使用从发表前的42.9%增加到发表后的86.8%（p < 0.0001），而蒽环类三联疗法的使用降至0.9%（p < 0.0001）。医院规模越大，采用FLOT的时间越短（p = 0.04），但在发表前采用FLOT的情况与医院规模无关（p = 0.14）。