Erin K Greenleaf1, Christopher S Hollenbeak2, Joyce Wong3. 1. Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA. 2. Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA; Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, PA. 3. Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA. Electronic address: jwong1@hmc.psu.edu.
Abstract
BACKGROUND: Standard of care for patients with advanced gastric cancer includes administration of neoadjuvant chemotherapy (NAC) before resection. This study assesses the pattern of use and impact of NAC on perioperative outcomes in US medical centers. METHODS: Using the American College of Surgeons National Cancer Database, 16,128 patients underwent gastrectomy for cancer from 2003 to 2012. Treatment groups were categorized as NAC or no NAC (ie, adjuvant chemotherapy and surgery only). Univariate and multivariate analyses were performed to estimate trends in utilization and impact of treatment on perioperative outcomes. RESULTS: Of patients undergoing gastrectomy, 36.6% received NAC and 63.4% did not receive chemotherapy in the neoadjuvant setting. Patients who received NAC were more frequently younger, male, white, privately insured, with fewer comorbidities, and treated at an academic center (all P < .0001). After controlling for demographics, comorbidities, and tumor-related factors, patients who received NAC had a postoperative duration of stay 0.43 days shorter than patients who did not receive chemotherapy (5.79 vs 6.22 days; P = .050). They had a 36% lower odds of 30-day mortality (odds ratio, 0.64, P < .0001) but nonsignificant lower odds of 90-day mortality. Use of NAC increased annually, with the greatest increases seen in academic facilities and in the Northeast and North Central United States. CONCLUSION: With concerns regarding the toxicity of NAC, these findings suggest that NAC is not associated with worse postoperative outcomes. In light of evidence touting the benefits of NAC, its adoption as a component in the multimodality care of gastric cancer is slowly increasing, although use of NAC remains poor overall.
BACKGROUND: Standard of care for patients with advanced gastric cancer includes administration of neoadjuvant chemotherapy (NAC) before resection. This study assesses the pattern of use and impact of NAC on perioperative outcomes in US medical centers. METHODS: Using the American College of Surgeons National Cancer Database, 16,128 patients underwent gastrectomy for cancer from 2003 to 2012. Treatment groups were categorized as NAC or no NAC (ie, adjuvant chemotherapy and surgery only). Univariate and multivariate analyses were performed to estimate trends in utilization and impact of treatment on perioperative outcomes. RESULTS: Of patients undergoing gastrectomy, 36.6% received NAC and 63.4% did not receive chemotherapy in the neoadjuvant setting. Patients who received NAC were more frequently younger, male, white, privately insured, with fewer comorbidities, and treated at an academic center (all P < .0001). After controlling for demographics, comorbidities, and tumor-related factors, patients who received NAC had a postoperative duration of stay 0.43 days shorter than patients who did not receive chemotherapy (5.79 vs 6.22 days; P = .050). They had a 36% lower odds of 30-day mortality (odds ratio, 0.64, P < .0001) but nonsignificant lower odds of 90-day mortality. Use of NAC increased annually, with the greatest increases seen in academic facilities and in the Northeast and North Central United States. CONCLUSION: With concerns regarding the toxicity of NAC, these findings suggest that NAC is not associated with worse postoperative outcomes. In light of evidence touting the benefits of NAC, its adoption as a component in the multimodality care of gastric cancer is slowly increasing, although use of NAC remains poor overall.
Authors: Naruhiko Ikoma; Prajnan Das; Wayne Hofstetter; Jaffer A Ajani; Jeannelyn S Estrella; Hsiang-Chun Chen; Xuemei Wang; Rashida A Callender; Cong Zhu; Christina L Roland; Keith F Fournier; Janice N Cormier; Paul Mansfield; Brian D Badgwell Journal: Gastric Cancer Date: 2018-05-05 Impact factor: 7.370
Authors: Naruhiko Ikoma; Mariela Blum; Jeannelyn S Estrella; Prajnan Das; Wayne L Hofstetter; Keith F Fournier; Paul Mansfield; Jaffer A Ajani; Brian D Badgwell Journal: Gastric Cancer Date: 2017-06-22 Impact factor: 7.370
Authors: Alexander P Stark; Mariela M Blum; Yi-Ju Chiang; Prajnan Das; Bruce D Minsky; Jeannelyn S Estrella; Jaffer A Ajani; Brian D Badgwell; Paul Mansfield; Naruhiko Ikoma Journal: J Gastric Cancer Date: 2020-09-17 Impact factor: 3.720
Authors: Naruhiko Ikoma; Janice N Cormier; Barry Feig; Xianglin L Du; Jose-Miguel Yamal; Wayne Hofstetter; Prajnan Das; Jaffer A Ajani; Christina L Roland; Keith Fournier; Richard Royal; Paul Mansfield; Brian D Badgwell Journal: Cancer Date: 2018-02-02 Impact factor: 6.860
Authors: Natalie Liu; Yiwei Xu; Amir A Rahnemai-Azar; Daniel E Abbott; Sharon M Weber; Anne O Lidor Journal: J Gastrointest Surg Date: 2019-12-02 Impact factor: 3.452
Authors: Rebecca Zhu; Fangfang Liu; Gabriella Grisotti; Javier Perez-Irizarry; Ronald R Salem; Charles H Cha; Kimberly L Johung; Daniel J Boffa; Yawei Zhang; Sajid A Khan Journal: J Gastrointest Oncol Date: 2018-06