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. 2020 Dec 24;28(1):138-151.
doi: 10.3390/curroncol28010017.

Gastric Cancer Treatments and Survival Trends in the United States

Kelly A Stahl  1 , Elizabeth J Olecki  1 , Matthew E Dixon  1 , June S Peng  1 , Madeline B Torres  1 , Niraj J Gusani  1 , Chan Shen  1   2
Affiliations

Gastric Cancer Treatments and Survival Trends in the United States

Kelly A Stahl et al. Curr Oncol. .

Abstract

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.

Keywords: National Cancer Database; cancer survival; gastric cancer; guideline concordant care; multimodal therapy; treatment trends.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Stage I gastric cancer treatment trends by percentage, stratified by year of diagnosis; 2004–2008, 2009–2012 or 2013–2016. (A) For patients with stage I disease there was a decreasing trend in receiving surgery alone and an increasing trend in receiving surgery and chemotherapy. The percentage of people receiving trimodality therapy remained roughly stable over this time period. (B) For patients with stage II/III disease there was an increased trend toward the receipt of chemoradiation as well as surgery and chemotherapy. A decreasing trend toward receiving surgery alone. The percentage of people receiving surgery and radiation as well as trimodality therapy remained roughly stable over this 13-year time period. (C) Stage IV gastric cancer treatment trends by percentage, stratified by year of diagnosis; 2004–2008, 2009–2012 or 2013-2016. For patients with stage IV disease there was an increased trend toward the receipt of chemotherapy. Overall surgical treatments declined over this time period in all categories; surgery alone, surgery and chemotherapy, surgery and radiation and trimodality therapy.
Figure 2
Figure 2
Kaplan-Meier analysis of all stages of gastric cancer 3-year overall survival stratified by year of diagnosis; 2004–2008, 2009–2012 or 2013–2016. For Stage I (A), Stage II/III (B) and Stage IV (C) survival is best when diagnosed in 2013–2016 and worst when diagnosed in 2004-2008 although not statistically significant.
Figure 3
Figure 3
Kaplan-Meier analysis of 3-year overall survival for gastric cancer stratified by receipt or non-receipt of guideline concordant. For Stage I disease (A) and Stage II/III disease (B) survival is significantly better when patients received stage specific guideline concordant care.
See this image and copyright information in PMC

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