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Adherence with operative standards in the treatment of gastric cancer in the United States

  • Beiqun Zhao
  • Sarah L. Blair
  • Matthew H. G. Katz
  • Andrew M. Lowy
  • Kaitlyn J. KellyEmail author
Original Article

Abstract

Background

Despite multiple clinical trials and practice guidelines for the treatment of gastric cancer, oncologic outcomes have not improved in the United States. One potential reason could be differences in the quality of surgery as performed in a controlled trial versus in practice.

Methods

Using the National Cancer Database, rates of adherence with operative standards for gastrectomy for cancer were analyzed. Of the numerous evidence-based operative standards outlined in the manual, two were reliably measured in the NCDB: (1) achieving and R0 resection, and (2) having > 16 lymph nodes examined. Univariable and multivariable Cox proportional hazard modeling and logistic regression were performed.

Results

A total of 28,705 patients with gastric adenocarcinoma who underwent curative-intent gastrectomy during 2004–2014 were identified. Only 36.5% of stage 0/I patients, and 41.8% of stage II/III patients, met minimum standards. Predictors for meeting standards included age < 65, fewer comorbidities, Asian/Pacific Islander race, and treatment at academic and high-volume centers. Patients who met standards had longer OS (stage 0/I: 104.9 versus 66.6 months; stage II/III: 40.6 versus 26.0 months; p < 0.001 for both). Meeting standards was a significant predictor for improved OS for both stage 0/I and II/III patients (HR = 0.665 and HR = 0.747, respectively, p < 0.001 for both).

Conclusions

For standards that are measurable in the NCDB, adherence is poor. Improved adherence with operative standards may improve survival for gastric cancer patients in the U.S. There is a need for better measuring of, and adherence with, operative standards in gastrectomy for cancer.

Keywords

Gastric cancer National Cancer Database NCDB Operative standards 

Notes

Compliance with ethical standards

Conflict of interest

Dr. Beiqun Zhao is supported by the National Library of Medicine Training Grant [NIH Grant: T15LM011271]. The funding source had no role in the design and/or general conduct of this study; had no access to the data or role in data collection, management, analysis, or interpretation; had no role in the preparation, review, or approval of the manuscript; and had no role in the decision to submit the manuscript for publication. The coauthors have no financial or other conflicts of interest to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Supplementary material

10120_2019_1028_MOESM1_ESM.docx (22 kb)
Supplementary material 1 (DOCX 23 kb)

References

  1. 1.
    Nelson H. American College of Surgeons, Alliance for Clinical Trials in Oncology. Operative standards for cancer surgery. Philadelphia: Wolters Kluwer Health; 2015.Google Scholar
  2. 2.
    Katz MH (ed). Operative Standards for Cancer Surgery: volume 2. American College of Surgeons Clinical Research Program. Philadelphia, PA: Wolters Kluwer; 2019.Google Scholar
  3. 3.
    Noone AMHN, Krapch M, Miller D, Brest A, Yu M, Ruhl J, Tatalovich Z, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975–2015. 2018; Bethesda, MD. https://seer.cancer.gov/csr/1975_2015/.
  4. 4.
    Al-Batran S HN, Schmalenberg H, Kopp J, Haag GM, Luley KB. Perioperative chemotherapy with docetaxel, oxaliplatin, and fluorouracil/leucovorin (FLOT) versus epirubicin, cisplatin, and fluorouracil or capecitabine (ECF/ECX) for resectable gastric or gastroesophageal junction (GEJ) adenocarcinoma (FLOT4-AIO): a multicenter, randomized phase 3 trial. J Clin Oncol. 2017;393(10184):1948–57.  https://doi.org/10.1016/S0140-6736(18)32557-1.CrossRefGoogle Scholar
  5. 5.
    Bang YJ, Kim YW, Yang HK, Chung HC, Park YK, Lee KH, et al. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. Lancet. 2012;379(9813):315–21.  https://doi.org/10.1016/s0140-6736(11)61873-4(Epub 2012/01/10).CrossRefPubMedGoogle Scholar
  6. 6.
    Bang YJ, Van Cutsem E, Feyereislova A, Chung HC, Shen L, Sawaki A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet. 2010;376(9742):687–97.  https://doi.org/10.1016/s0140-6736(10)61121-x(Epub 2010/08/24).CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355(1):11–20.  https://doi.org/10.1056/nejmoa055531(Epub 2006/07/11).CrossRefGoogle Scholar
  8. 8.
    Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med. 2007;357(18):1810–20.  https://doi.org/10.1056/nejmoa072252(Epub 2007/11/06).CrossRefPubMedGoogle Scholar
  9. 9.
    Japanese Gastric Cancer A. Japanese gastric cancer treatment guidelines 2010 (ver. 3). Gastric Cancer. 2011;14(2):113–23.  https://doi.org/10.1007/s10120-011-0042-4(Epub 2011/05/17).CrossRefGoogle Scholar
  10. 10.
    NCCN Clinical Practice Guidelines in Oncology. Gastric Cancer. 2018. https://www.nccn.org/professionals/physician_gls/pdf/gastric.pdf. Accessed 1 Aug 2019.
  11. 11.
    Macdonald JS, Smalley SR, Benedetti J, Hundahl SA, Estes NC, Stemmermann GN, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001;345(10):725–30.  https://doi.org/10.1056/nejmoa010187(Epub 2001/09/08).CrossRefPubMedGoogle Scholar
  12. 12.
    Lee J, Lim DH, Kim S, Park SH, Park JO, Park YS, et al. Phase III trial comparing capecitabine plus cisplatin versus capecitabine plus cisplatin with concurrent capecitabine radiotherapy in completely resected gastric cancer with D2 lymph node dissection: the ARTIST trial. J Clin Oncol. 2012;30(3):268–73.  https://doi.org/10.1200/jco.2011.39.1953(Epub 2011/12/21).CrossRefPubMedGoogle Scholar
  13. 13.
    Leong T, Smithers BM, Michael M, Gebski V, Boussioutas A, Miller D, et al. TOPGEAR: a randomised phase III trial of perioperative ECF chemotherapy versus preoperative chemoradiation plus perioperative ECF chemotherapy for resectable gastric cancer (an international, intergroup trial of the AGITG/TROG/EORTC/NCIC CTG). BMC Cancer. 2015;15:532.  https://doi.org/10.1186/s12885-015-1529-x(Epub 2015/07/22).CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Karanicolas PJ, Graham D, Gonen M, Strong VE, Brennan MF, Coit DG. Quality of life after gastrectomy for adenocarcinoma: a prospective cohort study. Ann Surg. 2013;257(6):1039–46.  https://doi.org/10.1097/sla.0b013e31828c4a19(Epub 2013/05/15).CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Kim JH, Park SS, Kim J, Boo YJ, Kim SJ, Mok YJ, et al. Surgical outcomes for gastric cancer in the upper third of the stomach. World J Surg. 2006;30(10):1870–6.  https://doi.org/10.1007/s00268-005-0703-8(discussion 7–8. Epub 2006/09/08).CrossRefPubMedGoogle Scholar
  16. 16.
    Beyer K, Baukloh AK, Kamphues C, Seeliger H, Heidecke CD, Kreis ME, et al. Laparoscopic versus open gastrectomy for locally advanced gastric cancer: a systematic review and meta-analysis of randomized controlled studies. World J Surg Oncol. 2019;17(1):68.  https://doi.org/10.1186/312957-019-1600-1.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Kelly KJ, Selby L, Chou JF, Dukleska K, Capanu M, Coit DG, et al. Laparoscopic versus open gastrectomy for gastric adenocarcinoma in the West: a case-control study. Ann Surg Oncol. 2015;22(11):3590–6.  https://doi.org/10.1245/s10434-015-4381-y.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Shi Y, Xu X, Zhao Y, Qian F, Tang B, Hao Y, et al. Long-term oncologic outcomes of a randomized controlled trial comparing laparoscopic versus open gastrectomy with D2 lymph node dissection for advanced gastric cancer. Surgery. 2019;165(6):1211–6.  https://doi.org/10.1016/j.surg.2019.01.003.CrossRefPubMedGoogle Scholar
  19. 19.
    Bickenbach KA, Gonen M, Strong V, Brennan MF, Coit DG. Association of positive transection margins with gastric cancer survival and local recurrence. Ann Surg Oncol. 2013;20(8):2663–8.  https://doi.org/10.1245/s10434-013-2950-5(Epub 2013/03/29).CrossRefPubMedGoogle Scholar
  20. 20.
    Memon MA, Subramanya MS, Khan S, Hossain MB, Osland E, Memon B. Meta-analysis of D1 versus D2 gastrectomy for gastric adenocarcinoma. Ann Surg. 2011;253(5):900–11.  https://doi.org/10.1097/sla.0b013e318212bff6(Epub 2011/03/12).CrossRefPubMedGoogle Scholar
  21. 21.
    Schmidt B, Chang KK, Maduekwe UN, Look-Hong N, Rattner DW, Lauwers GY, et al. D2 lymphadenectomy with surgical ex vivo dissection into node stations for gastric adenocarcinoma can be performed safely in Western patients and ensures optimal staging. Ann Surg Oncol. 2013;20(9):2991–9.  https://doi.org/10.1245/s10434-013-3019-1(Epub 2013/06/14).CrossRefPubMedGoogle Scholar
  22. 22.
    Schmidt B, Yoon SS. D1 versus D2 lymphadenectomy for gastric cancer. J Surg Oncol. 2013;107(3):259–64.  https://doi.org/10.1002/jso.23127(Epub 2012/04/20).CrossRefPubMedGoogle Scholar
  23. 23.
    Songun I, Putter H, Kranenbarg EM, Sasako M, van de Velde CJ. Surgical treatment of gastric cancer: 15-year follow-up results of the randomised nationwide Dutch D1D2 trial. Lancet Oncol. 2010;11(5):439–49.  https://doi.org/10.1016/s1470-2045(10)70070-x(Epub 2010/04/23).CrossRefPubMedGoogle Scholar

Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2019

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of California, San DiegoLa JollaUSA
  2. 2.Department of Surgical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA

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