Patterns of relapse in patients with localized gastric adenocarcinoma who had surgery with or without adjunctive therapy: costs and effectiveness of surveillance
Patterns of relapse in patients with localized gastric adenocarcinoma who had surgery with or without adjunctive therapy: costs and effectiveness of surveillance
复制标题
DOI：
10.18632/oncotarget.19226
复制
发表时间：
2017-10-06
期刊：
影响因子：
--
通讯作者：
Ajani, Jaffer A.
中科院分区：
文献类型：
--
作者：
Elimova, Elena;Slack, Rebecca S.;Ajani, Jaffer A.
目的：局限性胃腺癌 (GAC) 患者治疗后，监测费用、复发模式和挽救的可能性尚不清楚。材料和方法：我们确定了 246 名患者，他们在腹膜分期阴性后接受治疗（包括手术的任何治疗）并进行调查（前 3 年每 3-6 个月一次，然后每年一次；类似于每位患者 10 次 CT 和 7 次内窥镜检查）。我们使用2016年报销的医疗保险美元作为监测的“费用”。 结果：共同特征是：白种人（57%）、男性（60%）、低分化组织学（76%）、术前化疗（74%）、术前化放疗（59%）和接受过手术（100%）。中位随访时间为 3.7 年（范围为 0.1 至 18.3），中位总生存期 (OS) 为 9.2 年（95% CI，6.0 至 11.2）。肿瘤分级 (p = 0.02)、p/yp 分期 (p < 0.001)、残留 GAC 百分比 (p = 0.05)、R 状态 (p = 0.01)、全胃切除术 (p = 0.001) 和复发类型 (p = 0.02) 与 OS 相关。 79 名 (32%) 患者出现复发（仅 8% 为局部区域），其中 90% 发生在手术后 36 个月内。在多变量分析中，P/yp 分期 (p < 0.001) 和全胃切除术 (p = 0.01) 是 OS 的独立预测因素。只有 1 名复发患者进行了成功的挽救治疗。影像学检查和内窥镜检查的估计报销金额为 1,761,221.91 美元（明显低估了实际费用）。结论：局部 GAC 患者的中位 OS 非常好，局部区域复发很少。严格的监视收益低，“成本”高。我们的数据表明，可能需要减少监测间隔并限制对有症状患者进行昂贵的检查。
Purpose: After therapy of localized gastric adenocarcinoma (GAC) patients, the costs of surveillance, relapse patterns, and possibility of salvage are unknown.Materials and Methods: We identified 246 patients, who after having a negative peritoneal staging, received therapy (any therapy which included surgery) and were surveyed (every 3-6 months in the first 3 years, then yearly; similar to 10 CTs and similar to 7 endoscopies per patient). We used the 2016 Medicare dollars reimbursed as the "costs" for surveillance.Results: Common features were: Caucasians (57%), men (60%), poorly differentiated histology (76%), preoperative chemotherapy (74%), preoperative chemoradiation (59%), and had surgery (100%). At a median follow-up of 3.7 years (range, 0.1 to 18.3), the median overall survival (OS) was 9.2 years (95% CI, 6.0 to 11.2). Tumor grade (p = 0.02), p/yp stage (p < 0.001), % residual GAC (p = 0.05), the R status (p = 0.01), total gastrectomy (p = 0.001), and relapse type (p = 0.02) were associated with OS. Relapse occurred in 79 (32%) patients (only 8% were local-regional) and 90% occurred within 36 months of surgery. P/yp stage (p < 0.001) and total gastrectomy (p = 0.01) were independent prognosticators for OS in the multivariate analysis. Only 1 relapsed patient had successful salvage therapy. The estimated reimbursement for imaging studies and endoscopies was $1,761,221.91 (marked underestimation of actual costs).Conclusions: The median OS of localized GAC patients was excellent with infrequent local-regional relapses. Rigorous surveillance had a low yield and high "costs". Our data suggest that less frequent surveillance intervals and limiting expensive investigations to symptomatic patients may be warranted.