Benefit of Adjuvant Chemoradiation Therapy for Gastric Adenocarcinoma: A SEER Population Analysis

Seyedin, Steven N.; Wang, P.; Lee, P.

doi:10.1016/j.ijrobp.2013.06.782

Cited by 23 publications

(33 citation statements)

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“…The receipt of perioperative therapy is strongly associated with overall survival in our study and others. 30,31 Lastly, the extent of lymphadenectomy has been controversial in the United States, with data from 2 large randomized trials conducted in the 1990s reporting higher perioperative morbidity and mortality with the inclusion of distal pancreatectomy and splenectomy. 3,6,8,32 Subsequent studies have demonstrated that nearly one-third of patients will be upstaged when additional lymph nodes are examined in a D2 lymphadenectomy versus a D1 lymphadenectomy.…”

Section: Discussionmentioning

confidence: 99%

Integrated cancer networks improve compliance with national guidelines and outcomes for resectable gastric cancer

Thiels

Hanson

Habermann

et al. 2019

Cancer

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Background National Comprehensive Cancer Network (NCCN) guidelines recommend accurate clinical staging, perioperative therapy, and complete lymphadenectomy for patients with stage II to III gastric cancer. However, national compliance remains low. It was hypothesized that integrated cancer networks might improve compliance and outcomes within the community. Methods Patients with stage II to III gastric adenocarcinoma undergoing curative‐intent resection (National Cancer Data Base, 2006‐2015) were examined. Guideline compliance was defined as any perioperative adjunctive therapy, complete lymphadenectomy, complete clinical staging, and complete compliance (all measures). Univariate comparisons and multivariable regression were used to assess factors associated with compliance, and Kaplan‐Meier analysis was used to assess survival. Results There were 27,210 patients identified: 7235 (26.6%) underwent surgery alone, whereas 19,975 (73.4%) received additional therapy. Half (53.1%) had complete lymphadenectomies, whereas complete clinical staging was available for 65.5%. Overall compliance with all 3 measures was 30.1%. Compliance improved by approximately 20% for each measure across the 10‐year study period. Although patients treated at academic programs were most likely to receive concordant care in an adjusted analysis, those treated at integrated care networks were more likely to receive guideline‐concordant care (odds ratio [OR], 0.69) than those treated at comprehensive community programs (OR, 0.48) or community programs (OR, 0.45; all P values <.001). The median overall survival was 45.5 months for patients who received guideline‐concordant care and 32.0 months for those who did not (P < .001, reference for all ORs: academic programs). Conclusions Compliance with guidelines was associated with improved outcomes. Although the rate of compliance with NCCN guidelines is improving, integrated care networks may be an important way of improving the quality of gastric cancer care within the community.

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Section: Discussionmentioning

confidence: 99%

Integrated cancer networks improve compliance with national guidelines and outcomes for resectable gastric cancer

Thiels

Hanson

Habermann

et al. 2019

Cancer

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“…Seyedin et al compared surgery alone, surgery with chemotherapy, radiotherapy, or both in non-metastatic gastric adenocarcinoma patients between 1988 and 2008 using the SEER database [7]. They used cause-specific survival as an outcome to compare these modalities.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Worse Outcome in Early Stage Gastric Cancer Using the Surveillance, Epidemiology, and End Results (SEER) Database

Alnimer

Qasrawi²

2020

Cureus

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Background The benefit of adjuvant treatment in gastric adenocarcinoma patients with involvement of the muscularis propria but not beyond is unclear. We aim to establish a model that identifies the factors that adversely affect the prognosis in these patients. Methods We used the Surveillance, Epidemiology, and End Results (SEER) database to identify subjects with stage T2aN0M0 gastric adenocarcinoma who had tumor resection between 2004 and 2015. Data pertaining to the following variables were collected: age, gender, ethnicity, tumor size, grade, site, number of lymph nodes (LNs) being examined, and extent of surgery. Results A total of 1307 patients met our inclusion criteria. The five-year overall survival (OS) was 65%. The following factors were significantly associated with a shorter OS in univariate analysis. Age > 60 years, non-Hispanic whites and non-Hispanic blacks, patients with less than 15 lymph nodes examined at the time of surgery, tumors at the fundus and cardia of the stomach, and those who underwent endoscopic resection or had partial esophagectomy. On multivariate Cox regression, the following factors were predictors for worse OS: age > 60 years with a hazards ratio (HR) = 2.03 (95% CI: 1.49-2.76), patients with less than 15 lymph nodes examined with HR = 1.72 (95% CI: 1.34-2.20), non-Hispanic whites and non-Hispanic blacks with HR = 1.62 (95% CI: 1.26-2.08), and tumors within the cardia and fundus of the stomach with HR = 1.51 (95% CI: 1.21-1.89). Conclusion Patients with stage T2aN0M0 gastric cancer who had their tumor located at the cardia or fundus of the stomach or those with inadequate lymph nodes resection had inferior survival and could potentially benefit from adjuvant chemotherapy.

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“…Prior studies have used the SEER (11–15) and SEER-Medicare data (19, 20) to evaluate the association between adjuvant treatment and survival, primarily using data collected before CRT because part of standard care in 2002 or incomplete chemotherapy information. Using SEER-Medicare data collected since 2002 that includes detailed data on chemotherapy use, our current study adds to the growing body of evidence that suggests that adjuvant CRT, compared to gastrectomy alone, is associated with a survival benefit, in particular for patients diagnosed with more advanced stage II and III tumors.…”

Section: Discussionmentioning

confidence: 99%

“…Studies based on Surveillance, Epidemiology, and End Results (SEER) data report a survival benefit associated with adjuvant radiotherapy following gastrectomy (11–15). However, because the SEER program does not include detailed chemotherapy data, the benefit of CRT remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Comparative effectiveness of adjuvant chemoradiotherapy after gastrectomy among older patients with gastric adenocarcinoma: a SEER–Medicare study

et al. 2017

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Background Since the INT-0116 trial reported a survival advantage, post-operative chemoradiotherapy (CRT) has been a care standard for US patients diagnosed with gastric adenocarcinoma. We sought to estimate the association between treatment and survival among the older U.S. Medicare population. Methods Retrospective cohort study of Medicare beneficiaries aged 65–79 with stage IB-III gastric adenocarcinoma diagnosed between 2002 and 2009 in a Surveillance, Epidemiology, and End Results region. Patients were categorized based on treatment: 1) gastrectomy only, and 2) gastrectomy plus adjuvant CRT. We examined factors associated with adjuvant CRT receipt, including diagnosis stage, comorbidity, and tumor subtype. Overall survival was measured from 90 days post-gastrectomy until death or the censoring date of December 31, 2010. Results Of the 1519 patients who underwent gastrectomy, 41.7% received adjuvant CRT. Factors associated with adjuvant CRT included age <75 years of age at cancer diagnosis and stage II or III diagnosis. The median overall survival from time of gastrectomy was 25.1 months (interquartile range (IQR), 43.7 months) for gastrectomy only and 26.9 months (IQR, 40.9 months) for adjuvant CRT. Multivariable and propensity score-stratified models demonstrated a survival benefit associated with adjuvant CRT (HR = 0.58 (95%CI, 0.50–0.67), although the magnitude was greater for stage II (HR = 0.50; 95% CI, 0.39–0.61) and III (HR = 0.58; 95% CI, 0.45–0.73) tumors than stage IB (HR = 1.02; 95%CI, 0.71–1.45). Conclusions Adjuvant CRT, in conjunction with gastrectomy, was associated with a survival benefit among older patients diagnosed with stage II and III tumors.

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Benefit of Adjuvant Chemoradiation Therapy for Gastric Adenocarcinoma: A SEER Population Analysis

Cited by 23 publications

References 0 publications

Integrated cancer networks improve compliance with national guidelines and outcomes for resectable gastric cancer

Integrated cancer networks improve compliance with national guidelines and outcomes for resectable gastric cancer

Factors Associated with Worse Outcome in Early Stage Gastric Cancer Using the Surveillance, Epidemiology, and End Results (SEER) Database

Comparative effectiveness of adjuvant chemoradiotherapy after gastrectomy among older patients with gastric adenocarcinoma: a SEER–Medicare study

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