In patients (pts) with non-metastatic GC, MMT added to surgery improves the cure rate. The MMT includes adjuvant chemoradiation (ACR), neoadjuvant chemoradiation (NACR), and perioperative chemotherapy (CT). We used the NCDB data to compare different MMT in pts with non-metastatic GC.
A total of 79369 pts with non-metastatic GC diagnosed 2004- 2013 were identified. Pts with known tumor site who underwent surgery and received MMT were selected for this analysis. Treatment included NACR, CT, and ACR. Pts divided into two cohorts cardia GC (cGC) and non-cardia GC (nGC). Among 10796 pts with cGC and 10681 with nGC, demographics, tumor characteristics, and treatment data were abstracted. Overall survial (OS) was selected as the primary study outcome. Cox regression model was used to examine the effect of choice of MMT on OS adjusting for all known prognostic factors.
Summary of results included in the table. In 10796 pts with cGC MMT distribution was 24%, 55%, and 21% for ACR, NACR, and CT. These numbers for nGC were 10681, 55%, 7%, and 38%. OS in the treament groups: ACR 42.1 (95%CI: 42.2-44.1), NACR 35.9 (95%CI: 34.2-37.9), CT 34.2 (32.7 -35.8). In cGC, ACR remained superior with median OS of 36.4 (34.5-39.0) vs. NACR 34.0 (32.5-35.6: HR 1.13) and CT 33.3 (31.2-35.6: HR 1.11) p
ACR increased the odds of survival by 20% in the nGC and by 10% in cGC pts. Although this is a retrospective analysis the large sample size and long follow up provides confidence in the observation. There is a statistically significat difference in the presentation and outcomes of cGC and nGC. Caution should be exercised in combining these pts in prospective trials.
Clinical trial identification
Legal entity responsible for the study
USC/ Norris Comprehensive Cancer Center
University of Southern California, Norris Comprehensive Cancer Center
All authors have declared no conflicts of interest.