Skip to main content

Advertisement

SpringerLink
Log in

Chinese Medicine Prolongs Overall Survival of Chinese Patients with Advanced Gastric Cancer: Treatment Pattern and Survival Analysis of a 20-Year Real-World Study

  • Original Article
  • Published:
Chinese Journal of Integrative Medicine Aims and scope Submit manuscript

Abstract

Objective

To describe the treatment patterns and survival status of advanced gastric cancer (AGC) in China in the past two decades, and objectively evaluate the impact of standardized Chinese medicine (CM) treatment on the survival of AGC patients.

Methods

This multicenter registry designed and propensity score analysis study described the diagnosis characteristics, treatment-pattern development and survival status of AGC from 10 hospitals in China between January 1, 2000 and July 31, 2021. Overall survival (OS) was evaluated between non-CM cohort (standard medical treatment) and CM cohort (integrated standard CM treatment ≥3 months). Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were performed to adjust any difference in average outcomes for bias.

Results

A total of 2,001 patients histologically confirmed locally advanced and/or metastasis stomach and gastroesophageal junction adenocarcinoma were enrolled. Among them, 1,607 received systemic chemotherapy, 215 (10.74%) accepted molecular targeted therapy, 44 (2.2%) received checkpoint inhibitor therapy, and 769 (38.43%) received CM. Two-drug regimen was the main choice for first-line treatment, with fluoropyrimidine plus platinum as the most common regimen (530 cases, 60.09%). While 45.71% (16 cases) of patients with HER2 amplification received trastuzumab in first-line. The application of apatinib increased (33.33%) in third-line. The application of checkpoint inhibitors has increased since 2020. COX analysis showed that Lauren mixed type (P=0.017), cycles of first-line treatment >6 (P=0.000), CM (P=0.000), palliative gastrectomy (P=0.000), trastuzumab (P=0.011), and apatinib (P=0.008) were independent prognostic factors for the OS of AGC. After PSM and IPTW, the median OS of CM cohort and non-CM cohort was 18.17 and 12.45 months, respectively (P<0.001).

Conclusions

In real-world practice for AGC in China, therapy choices consisted with guidelines. Two-drug regimen was the main first-line choice. Standardized CM treatment was an independent prognostic factor and could prolong the OS of Chinese patients with AGC. (Registration No. NCT02781285)

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71:209–249.

    Article  PubMed  Google Scholar 

  2. Xia CF, Dong XS, Li H, Cao MM, Sun DQ, He SY, et al. Cancer statistics in China and United States, 2022: profiles, trends, and determinants. Chin Med J 2022;135:584–590.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Qi CS, Cheng SY, Shen L. Current status and research progress of third-line treatment for gastric cancer patients in China. Chin J Oncol (Chin) 2020;42:983–988.

    CAS  Google Scholar 

  4. Cutsem EV, Moiseyenko VM, Tjulandin S, Majlis A, Constenla M, Boni C, et al. V325 Study Group. Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: a report of the V325 Study Group. J Clin Oncol 2006;24:4991–4997.

    Article  PubMed  Google Scholar 

  5. Koizumi W, Narahara H, Hara T, Takagane A, Akiya T, Takagi M, et al. S-1 plus cisplatin versus S-1 alone for first line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol 2008;9:215–221.

    Article  CAS  PubMed  Google Scholar 

  6. Bang YJ, Cutsem EV, Feyereislova A, Chung HC, Shen L, Sawaki A, et al. ToGA Trial Investigators. 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;376:687–697.

    Article  CAS  PubMed  Google Scholar 

  7. Rye MH, Yoo CH, Kim JG, Ryoo BY, Park YS, Park SR, et al. Multicenter phase II study of trastuzumab in combination with capecitabine and oxaliplatin for advanced gastric cancer. Eur J Cancer 2015;51:482–488.

    Article  Google Scholar 

  8. Yelena Y, Shitara K, Moehler M, Garrido M, Salman P, Shen L, et al. First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastroesophageal junction, and esophageal adenocarcinoma (CheckMate 649): a randomized open-label, phase 3 trial. Lancet 2021;398:27–40.

    Article  Google Scholar 

  9. Xu JM, Jiang HP, Pan YY, Gu KS, Cang SD, Han L, et al. Sintilimab plus chemotherapy for unresectable gastric or gastroesophageal junction cancer: the ORIENT-16 randomized clinical trial. JAMA 2023;330:2064–2074.

    Article  PubMed  Google Scholar 

  10. Xu Y, Zhao AG, Li ZY, Zhao G, Cai Y, Zhu XH, et al. Survival benefit of traditional Chinese herbal medicine (a herbal formula for invigorating spleen) for patients with advanced gastric cancer. Integr Cancer Ther 2013;12:414–422.

    Article  PubMed  Google Scholar 

  11. Li J, Niu JQ, Yang M, Ye PZ, Zhai JB, Yuan WZ, et al. Using single-patient (n-of-1) trials to determine effectiveness of traditional Chinese medicine on chemotherapy-induced leukopenia in gastric cancer: a feasibility study. Ann Transl Med 2019;7:124.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Duan LX, Zheng J, Zhao AG, Zhu XH, Gao F, Cao ND, et al. A contemporaneous control study on the effect of TCM syndrome differentiation on the prognosis of elderly patients with advanced gastric cancer. J Chin Oncol 2018;24:800–807.

    Google Scholar 

  13. Hsieh YL, Chou LW, Hong SF, Chang FC, Tseng SW, Huang CC, et al. Laser acupuncture attenuates oxaliplatin-induced peripheral neuropathy in patients with gastrointestinal cancer: a pilot prospective cohort study. Acupunct Med 2016;34:398–405.

    Article  PubMed  Google Scholar 

  14. Zhang X, Yuan Y, Xi YP, Xu XY, Guo QJ, Zheng HG, et al. Cinobufacini Injection improves the efficacy of chemotherapy on advanced stage gastric cancer: a systemic review and meta-analysis. Evid Based Complement Alternat Med 2018;2018:7362340.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Department of Medical Administration of the State Administration of Traditional Chinese Medicine. Traditional Chinese medicine diagnosis and treatment plan for gastric cancer. Beijing: Department of Medical Administration of the State Administration of Traditional Chinese Medicine; 2011:323–329.

    Google Scholar 

  16. Ministry of Health of P.R. China Diagnosis and Treatment Guidelines for gastric cancer (2011 edition). Available at: www.nhc.gov.cn/. Accessed February 16, 2011.

  17. The 7th edition of American Joint Committee on Cancer (AJCC)/International Union Against Cancer (UICC) TNM staging system for gastric cancer (2010). Available at: http://www.nccn.org. Accessed January 1, 2011.

  18. The 8th edition of American Joint Committee on Cancer (AJCC)/International Union Against Cancer (UICC) TNM staging system for gastric cancer (2017). Available at: http://www.nccn.org. Accessed January 1, 2018.

  19. Zhou JC, ed. Practice of medical oncology. Beijing: People’s Medical Publishing House; 2005:47–48.

    Google Scholar 

  20. Cauchy F, Fuks D, Nomi T, Dokmak S, Scatton O, Schwarz L, et al. Benefits of laparoscopy in elderly patients requiring major liver resection. J Am Coll Surg 2015;222:174–184.

    Article  PubMed  Google Scholar 

  21. Kwon Y, Han HS, Yoon YS, Cho JY. Are large hepatocellular carcinomas still a contraindication for laparoscopic liver resection? J Laparoendosc Adv Surg Tech A 2015;25:98–102.

    Article  PubMed  Google Scholar 

  22. Lin CW, Tsai TJ, Cheng TY, Wei HK, Hung CF, Chen YY, et al. The learning curve of laparoscopic liver resection after the Louisville statement 2008: will it be more effective and smooth? Surg Endosc 2016;30:2895–2903.

    Article  PubMed  Google Scholar 

  23. Brookhart MA, Schneeweiss S, Rothman KJ, Glynn RJ, Avorn J, Stürmer T. Variable selection for propensity score models. Am J Epidemiol 2006;163:1149–1156.

    Article  PubMed  Google Scholar 

  24. Simmonds PC, Primrose JN, Colquitt JL, Garden OJ, Poston GJ, Rees M. Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies. Br J Cancer 2006;94:982–999.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Kanas GP, Taylor A, Primrose JN, Langeberg WJ, Kelsh MA, Mowat FS, et al. Survival after liver resection in metastatic colorectal cancer: review and meta-analysis of prognostic factors. Clin Epidemiol 2012;4:283–301.

    PubMed  PubMed Central  Google Scholar 

  26. National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology Gastric Cancer 2011 V.1. Available at: http://www.nccn.org. Accessed 2011.

  27. Luo HY, Xu RH, Wang F, Qiu MZ, Li YH, Li FH, et al. Phase II trial of XELOX as first-line treatment for patients with advanced gastric cancer. Chemotherapy 2010;56:94–100.

    Article  CAS  PubMed  Google Scholar 

  28. Xu RH, Wang ZQ, Shen L, Wang W, Lu JW, Dai GH, et al. S-1 plus oxaliplatin versus S-1 plus cisplatin as first-line treatment for advanced diffuse-type or mixed-type gastric/gastroesophageal junction adenocarcinoma: a randomized, phase 3 trial. J Clin Oncol 2019;37:4017.

    Article  Google Scholar 

  29. Qin SK, Ji JF, Xu RH, Wang W, Tang Y, Bi F, et al. Treatment patterns and outcomes in Chinese gastric cancer by HER2 status: a non-interventional registry study (EVIDENCE). Oncologist 2021;26:e1567–e1580.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Li J, Qin SK, Xu JM, Xiong JP, Wu CP, Bai YX, et al. Randomized, double-blind, placebo-controlled phase III trial of apatinib in patients with chemotherapy-refractory advanced or metastatic adenocarcinoma of the stomach or gastroesophageal junction. J Clin Oncol 2016;34:1448–1454.

    Article  CAS  PubMed  Google Scholar 

  31. Peng WR, Zhang FL, Wang ZS, Li DL, He YF, Ning ZL, et al. Large scale, multicenter, prospective study of apatinib in advanced gastric cancer: a real-world study from China. Cancer Manag Res 2020;12:6977–6985.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Zhao L, Zhao AG, Zhao G, Xu Y, Zhu XH, Cao ND, et al. Survival benefit of traditional Chinese herbal medicine (a herbal formula for invigorating spleen) in gastric cancer patients with peritoneal metastasis. Evid Based Complement Alternat Med 2014;2014:625493.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Xu Y, Zhao AG, Zhao QF, Zhu XH, Cao ND, Liu TS, et al. Clinical evaluation of spleen-strengthening traditional Chinese medicine compound in improving the prognosis of female advanced gastric cancer. J Shanghai Univ Tradit Chin Med (Chin) 2018;32:22–27.

    CAS  Google Scholar 

  34. Zhu XH, Zhao AG, Li HW, Cao ND, Xu Y, Zhao G, et al. To explore the effect of syndrome differentiation treatment based on spleen strengthening on the disease-free survival of patients with stage III C gastric cancer after radical gastrectomy. China Cancer (Chin) 2016;25:569–574.

    Google Scholar 

  35. Chen B, Zhao AG, Shao J, Mu XY, Jiang L, Liu JW, The effects of PTBP3 silencing on the proliferation and differentiation of MKN45 human gastric cancer cells. Life sciences 2014; 114:29–35.

    Article  CAS  PubMed  Google Scholar 

  36. Zhang GT, Li ZY, Dong JH, Zhou WL, Zhang ZX, Que ZJ, et al. Acacetin inhibits invasion, migration and TGF-β1-induced EMT of gastric cancer cells through the PI3K/Akt/Snail pathway. BMC Complementary Med Ther 2022;22:10.

    Article  Google Scholar 

  37. Liao YY, Peng NF, Long D, Yu PC, Zhang S, Zhong JH, et al. Hepatectomy for liver metastases from gastric cancer: a systematic review. BMC Surg 2017;17:14.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Markar SR, Mikhail S, Malietzis G, Athanasiou T, Mariette C, Sasako M, et al. Influence of of surgical resection of hepatic metastases from gastric adenocarcinoma on long-term survival: systematic review and pooled analysis. Ann Surg 2016;263:1092–1101.

    Article  PubMed  Google Scholar 

  39. Brieau B, Auzolle C, Pozet A, Tougeron D, Bouche O, Soibinet P, et al. Efficacy of modern chemotherapy and prognostic factors in patients with ovarian metastases from gastric cancer: a retrospective AGEO multicentre study. Dig Liver Dis 2016;48:441–445.

    Article  CAS  PubMed  Google Scholar 

  40. Aurello P, Berardi G, Antolino L, Antonelli G, Rampini A, Moschetta G, et al. Is a surgical approach justified in metachronous krukenberg tumor from gastric caner? A systematic review. Oncol Res Treat 2018;41:644–649.

    Article  PubMed  Google Scholar 

Download references

Acknowledgement

Special appreciation and deep in memoriam to Prof. ZHAO Gang, former Administrative Deputy Director of Department of Gastrointestinal Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, for his contribution to gastrointestinal surgery and proactive promotion on long-term academic cooperation.

Author information

Authors and Affiliations

  1. Oncology Department I, Longhua Hospital Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China

    Ni-da Cao, Xiao-hong Zhu, Fang-qi Ma, Yan Xu, Jia-huan Dong, Meng-meng Qin & Ai-guang Zhao

  2. Oncology Department, Zhongshan Hospital, Fudan University, Shanghai, 200032, China

    Tian-shu Liu

  3. Gastrointestinal Surgery Department, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, China

    Chun-chao Zhu

  4. Oncology Department, Fudan University Shanghai Cancer Center, Shanghai, 200032, China

    Wei-jian Guo

  5. Oncology Department, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200080, China

    Hong-hua Ding

  6. Traditional Chinese Medicine Department, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China

    Yuan-biao Guo

  7. Oncology Department, Shanxi Traditional Chinese Medicine Hospital, Taiyuan, 030012, China

    Li-kun Liu

  8. Oncology Department, Xiyuan Hospital, China Academy of Chinese Medical Science, Beijing, 102445, China

    Jin-jie Song

  9. Oncology Department, Yunnan Province Hospital of Traditional Chinese Medicine, Kunming, 650021, China

    Ji-ping Wu

  10. Oncology Department, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China

    Yue-lei Cheng

  11. Shanghai NewCore Biotechnology Co., Ltd., Shanghai, 200240, China

    Lin Zeng

Authors
  1. Ni-da Cao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiao-hong Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fang-qi Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yan Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jia-huan Dong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Meng-meng Qin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tian-shu Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Chun-chao Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Wei-jian Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hong-hua Ding
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Yuan-biao Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Li-kun Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Jin-jie Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Ji-ping Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Yue-lei Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Lin Zeng
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Ai-guang Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Cao ND wrote the main text of manuscript; Ma FQ, Dong JH, Qin MM contributed to the data collection and following-up; Zhao AG, Zhu XH, Xu Y, Liu TS, Zhu CC, Guo WJ, Ding HH, Guo YB, Liu LK, Song JJ, Wu JP, Cheng YL contributed to the case enrollment; Zeng L contributed to the statistics analysis. All authors have reviewed the manuscript and approved the final version of the article.

Corresponding author

Correspondence to Ai-guang Zhao.

Ethics declarations

There are no financial disclosures from any authors.

Additional information

Supported by National Natural Science Foundation of China (No. 82004133), “Three-Year Action Plan” of Shanghai Traditional Chinese Medicine Development Office of Shanghai Health Commission (No. ZY3-CCCX-3-2003), and Shanghai “Science and Technology Innovation Action Plan” Medical Innovation Research Project, Shanghai Clinical Research Center of Traditional Chinese Medicine Oncology (No. 21MC1930500)

Supplementary material

11655_2024_4107_MOESM1_ESM.pdf

Chinese Medicine Prolongs Overall Survival of Chinese Patients with Advanced Gastric Cancer: Treatment Pattern and Survival Analysis of a 20-Year Real-World Study

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cao, Nd., Zhu, Xh., Ma, Fq. et al. Chinese Medicine Prolongs Overall Survival of Chinese Patients with Advanced Gastric Cancer: Treatment Pattern and Survival Analysis of a 20-Year Real-World Study. Chin. J. Integr. Med. 30, 489–498 (2024). https://doi.org/10.1007/s11655-024-4107-8

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11655-024-4107-8

Keywords

Search

Navigation