No improvement in median survival for patients with metastatic gastric cancer despite increased use of chemotherapy
No improvement in median survival for patients with metastatic gastric cancer despite increased use of chemotherapy
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DOI：
10.1093/annonc/mdt401
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发表时间：
2013-12-01
影响因子：
50.5
通讯作者：
Lemmens, V. E. P. P.
中科院分区：
文献类型：
--
作者：
Bernards, N.;Creemers, G. J.;Lemmens, V. E. P. P.
胃癌通常处于转移期。我们进行了一项以人群为基础的研究，以评估转移性非贲门型胃癌的系统治疗和生存率的趋势。纳入了1990年至2011年在荷兰埃因霍温癌症登记区诊断的所有胃非贲门腺癌患者(N=4797)。我们进行了多变量Logistic回归分析来评估姑息化疗的应用趋势，并进行了多变量比例风险回归分析来评估总体生存率的趋势。转移性胃癌患者的比例从1990年的24%上升到2011年的44%(P<；0.0001)。姑息化疗的使用率从1990年的5%上升到2011年的36%，特别是在2006年之后出现了强劲增长(P<；0.0001)。较年轻的患者[50岁：调整后的优势比(ORADJ)3.9，P<；0.001；50-59岁：ORADJ1.7，P=0.01]和社会经济地位高的患者(ORADJ1.7，P=0.01)更常接受化疗。相比之下，高龄患者(70-79岁：ORadj0.3，P<；0.001；80岁以上：ORadj0.02，P<；0.001)、合并疾病(ORadj0.6，P=0.03)、塑化性线炎(ORadj0.5，P=0.03)和多发性远处转移(ORadj0.5，P=0.01)患者较少接受化疗。姑息化疗在医院的应用有很大的差异(9%-27%)。中位总生存期在15周[95%可信区间(CI)11.9-17.7]至17周(95%可信区间15.0-20.0)之间保持不变(P=0.10)。转移性胃癌患者增加化疗并不会导致总体生存率的增加。确定从姑息化疗中受益的患者亚群对于避免不必要的治疗是至关重要的。
Gastric cancer often presents in a metastasized stage. We conducted a population-based study to evaluate trends in systemic treatment and survival of metastatic noncardia gastric cancer.All patients with noncardia adenocarcinoma of the stomach, diagnosed between 1990 and 2011 in the Eindhoven Cancer Registry area in the Netherlands were included (N = 4797). We conducted multivariable logistic regression analysis to evaluate trends in administration of palliative chemotherapy and multivariable proportional hazards regression analyses to evaluate trends in crude overall survival.The proportion of patients presenting with metastatic gastric cancer increased from 24% in 1990 to 44% in 2011 (P < 0.0001). The use of palliative chemotherapy increased, from 5% in 1990 to 36% in 2011, with a strong increase in particular after 2006 (P < 0.0001). Younger patients [< 50 years: adjusted odds ratio (ORadj) 3.9, P < 0.001; 50-59 years: ORadj 1.7, P = 0.01] and patients with a high socioeconomic status (ORadj 1.7, P = 0.01) more often received chemotherapy. In contrast, older patients (70-79 years: ORadj 0.3, P < 0.001; 80+ years: ORadj 0.02, P < 0.001), patients with comorbidity (ORadj 0.6, P = 0.03), linitis plastica (ORadj 0.5, P = 0.03) and multiple distant metastases (ORadj 0.5, P = 0.01) were less often treated with chemotherapy. A large hospital variation was observed in the administration of palliative chemotherapy (9%-27%). Median overall survival remained constant between 15 [95% confidence interval (CI) 11.9-17.7] and 17 (95% CI 15.0-20.0) weeks (P = 0.10).The increased administration of chemotherapy in patients with metastatic gastric cancer did not lead to an increase in population-based overall survival. Identification of the subgroup of patients which benefits from palliative chemotherapy is of utmost importance to avoid unnecessary treatment.