Evaluating Dissemination of Adequate Lymphadenectomy for Gastric Cancer in the USA

Abstract

Background: Adequate lymphadenectomy (AL) of 15+ lymph nodes comprises an important component of gastric cancer surgical therapy. Despite endorsement by the National Comprehensive Cancer Network and the Committee on Cancer, initial adoption of this paradigm has been relatively slow. The current analysis sought to perform an adjusted time-trend evaluation of the factors associated with AL and its dissemination.

Methods: Utilizing the 2004-2015 National Cancer Database, 28,985 patients were identified who underwent gastrectomy for adenocarcinoma. An adjusted time-trend analysis was performed to estimate the adoption of AL overall. Multivariable logistic regression was utilized to assess factors associated with these observed trends. Interactions and stratified models determined disparate effects in vulnerable populations (older adults, ethnic minorities, low socioeconomic status).

Results: The adjusted time-trend analysis demonstrated an overall 30% increase (28.8 to 58.7%) in receipt of AL (OR 1.10 increase/year; 95%CI 1.09-1.10) from 2004 to 2015. This trend persisted even after stratifying the models by age, race/ethnicity, and income (OR 1.07-1.12; p < 0.05). Slowest rates of adoption were seen amongst hospitals in the Midwest census region (OR 1.08, CI 1.06-1.90) and comprehensive community hospitals (OR 1.08, CI 1.06-1.91) and with African-American patients (OR 1.09, CI 1.06-1.11) (all p < 0.05).

Conclusion: This multi-center evaluation demonstrates increased adoption of AL during gastric cancer surgery in the USA overall and amongst vulnerable populations, although regional and racial disparities were observed. Future studies are needed to investigate reasons underlying racial and regional differences in receipt of AL.

Keywords: Cancer; Disparity; Gastric; Lymphadenectomy; Outcomes; Volume.