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Preoperative chemoradiation therapy induces primary-tumor complete response more frequently than chemotherapy alone in gastric cancer: analyses of the National Cancer Database 2006–2014 using propensity score matching
- Source :
- Gastric Cancer. 21:1004-1013
- Publication Year :
- 2018
- Publisher :
- Springer Science and Business Media LLC, 2018.
-
Abstract
- BACKGROUND: The benefit of preoperative chemoradiation (CXRT) over preoperative chemotherapy alone (“chemotherapy” hereafter) is unknown. By analyzing the National Cancer Database (NCDB), we investigated whether preoperative CXRT improves the incidence of primary tumor pathologic complete response (ypT0) and overall survival (OS) compared with preoperative chemotherapy in patients with gastric cancer. METHODS: Patients with non-metastatic gastric adenocarcinoma who underwent CXRT or chemotherapy followed by gastrectomy were included. Propensity score matching with a ratio of 1:1 was implemented to reduce selection bias. A conditional logistic regression model was used to compare incidences of ypT0 between groups, and Cox proportional hazards model was used to compare OS. RESULTS: We identified 8,464 patients. Median patient age was 63 years; 76% were male and 79% were white. ypT0 was observed in 16.1% of patients in the CXRT group and 6.6% in the chemotherapy group (p < 0.001). After propensity score matching, a total of 2,408 patients were matched. CXRT was associated with a higher incidence of ypT0 (OR 2.28, 95% CI 1.76–2.95; p < 0.0001) and higher frequency of R0 resection (92% vs. 86%; p < 0.001). However, CXRT was not associated with longer OS (HR 1.03, 95% CI 0.92–1.15; p = 0.63). Safety profiles (30-day mortality, 30-day readmission, and length of hospital stay) were equivalent between groups. CONCLUSIONS: In this study of gastric cancer patients from the NCDB, CXRT was associated with a higher incidence of ypT0 and R0 resection compared with chemotherapy, although it was not associated with a longer OS.
- Subjects :
- Male
Cancer Research
Databases, Factual
medicine.medical_treatment
Adenocarcinoma
computer.software_genre
Preoperative care
Article
Cohort Studies
03 medical and health sciences
0302 clinical medicine
Stomach Neoplasms
Preoperative Care
medicine
Humans
030212 general & internal medicine
Propensity Score
Survival analysis
Aged
Retrospective Studies
Database
Proportional hazards model
business.industry
Gastroenterology
Cancer
Retrospective cohort study
Chemoradiotherapy, Adjuvant
General Medicine
Middle Aged
medicine.disease
Survival Analysis
Primary tumor
United States
Treatment Outcome
Oncology
Chemotherapy, Adjuvant
030220 oncology & carcinogenesis
Propensity score matching
Female
Gastrectomy
business
computer
Subjects
Details
- ISSN :
- 14363305 and 14363291
- Volume :
- 21
- Database :
- OpenAIRE
- Journal :
- Gastric Cancer
- Accession number :
- edsair.doi.dedup.....c05688d8e042e34df77c555c8712a911