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Treatment Trends and Predictors of Adjuvant and Neoadjuvant Therapy for Gastric Adenocarcinoma in the United States

  • Healthcare Policy and Outcomes
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Over the last decade, evidence suggesting the benefits of adjuvant therapy in the treatment of stage IB–III gastric adenocarcinoma has emerged, though the influence of these clinical trials and current treatment patterns is unknown. Our objectives were (1) to assess changes in gastric adenocarcinoma treatment over time, (2) to identify predictors of neoadjuvant or postoperative adjuvant therapy use, and (3) to identify factors associated with neoadjuvant therapy use.

Methods

Patients with stage IB–III gastric adenocarcinoma diagnosed between 1998 and 2007 in the National Cancer Data Base who underwent surgical resection were selected. Models were developed to identify factors associated with treatment.

Results

We identified 30,448 patients diagnosed with stage IB–III gastric adenocarcinoma who underwent surgical resection. Rates of systemic therapy receipt (either before or after surgery) increased by 71 % from 1998 to 2007 (p < 0.001). Receipt of neoadjuvant therapy receipt increased by 237 % over 10 years (p < 0.001), with the highest rate of increase seen at high-volume academic centers. American Joint Committee on Cancer (AJCC) stage and age were the strongest predictors of pre- or postoperative systemic therapy among surgical patients. Neoadjuvant therapy receipt was most strongly predicted by tumor location in the gastric cardia.

Conclusions

Treatment trends over the past decade reflect rapid adoption of evidence from randomized controlled trials by increased receipt of pre- and postoperative systemic therapy in the treatment of stage IB–III gastric adenocarcinoma. Although age and AJCC stage are strongly associated with receiving systemic adjuvant therapy, tumor location is the most significant predictor of neoadjuvant therapy.

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Acknowledgment

D. J. Bentrem is supported by a Career Development Award from the Health Services Research and Development Service of the Department of Veterans Affairs and the Nathan and Isabel Miller Family Foundation. The authors thank the Nathan and Isabel Miller Family Foundation for their support.

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Authors and Affiliations

  1. Department of Surgery, Surgical Outcomes and Quality Improvement Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Karen L. Sherman MD, Ryan P. Merkow MD, Karl Y. Bilimoria MS, MD, C. Edward Wang PhD & David J. Bentrem MS, MD

  2. Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA

    Ryan P. Merkow MD

  3. Department of Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Mary F. Mulcahy MD & Al B. Benson MD

  4. Department of Surgery, Jesse Brown VA Medical Center, Chicago, IL, USA

    David J. Bentrem MS, MD

Authors
  1. Karen L. Sherman MD
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  2. Ryan P. Merkow MD
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  3. Karl Y. Bilimoria MS, MD
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  4. C. Edward Wang PhD
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  5. Mary F. Mulcahy MD
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  6. Al B. Benson MD
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  7. David J. Bentrem MS, MD
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Corresponding author

Correspondence to David J. Bentrem MS, MD.

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Sherman, K.L., Merkow, R.P., Bilimoria, K.Y. et al. Treatment Trends and Predictors of Adjuvant and Neoadjuvant Therapy for Gastric Adenocarcinoma in the United States. Ann Surg Oncol 20, 362–370 (2013). https://doi.org/10.1245/s10434-012-2552-7

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  • DOI: https://doi.org/10.1245/s10434-012-2552-7

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