No improvement in median survival for patients with metastatic gastric cancer despite increased use of chemotherapy.

Abstract

BACKGROUND:

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.

PATIENTS AND METHODS:

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.

RESULTS:

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).

CONCLUSIONS:

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.

• Authors: N Bernards, G J Creemers, G A P Nieuwenhuijzen, K Bosscha, J F M Pruijt, V E P P Lemmens
• Journal: Annals of oncology : official journal of the European Society for Medical Oncology (Ann Oncol) Vol. 24 Issue 12 Pg. 3056-60 (Dec 2013) ISSN: 1569-8041 [Electronic] England
• PMID: 24121120 (Publication Type: Journal Article)

Chemical References

• Antineoplastic Agents

Topics

• Aged
• Aged, 80 and over
• Antineoplastic Agents (therapeutic use)
• Female
• Humans
• Liver Neoplasms (drug therapy, mortality, secondary)
• Logistic Models
• Lung Neoplasms (drug therapy, mortality, secondary)
• Male
• Middle Aged
• Multivariate Analysis
• Proportional Hazards Models
• Stomach Neoplasms (drug therapy, mortality, pathology)
• Treatment Outcome