Urgent Surgery for Gastric Adenocarcinoma: A Study of the National Cancer Database

Introduction With advances in multimodal therapy, survival rates in gastric cancer have significantly improved over the last two decades. Neoadjuvant therapy increases the likelihood of achieving negative margins and may even lead to pathologic complete response (pCR). However, the impact of pCR on survival in gastric cancer has been poorly described. We analyzed the rate and predictors of pCR in patients receiving neoadjuvant therapy as well as impact of pCR on survival. Methods We conducted a National Cancer Database (NCDB) analysis (2004-2016) of patients with gastric adenocarcinoma who received neoadjuvant chemotherapy followed by surgical resection. Results The pCR rate was 2.2%. Following adjustment, only neoadjuvant chemoradiation, non-signet histology, and tumor grade remained as significant factors predicting pCR. pCR was a statistically significant predictor of survival. Conclusion In this NCDB study, pCR was a predictor of survival. Though chemoradiation rather than chemotherapy alone was a predictor of pCR, it was not a predictor of survival. Further studies are needed to elucidate the role of radiation in the neoadjuvant setting and to discern the impact of pCR on survival.

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Robotic versus laparoscopic gastrectomy for gastric adenocarcinoma: Propensity matched analysis of the National Cancer Database.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.104 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 104-104

Author(s):

Sean Ryan ◽

Amy Murphy ◽

Ashley Tameron ◽

Lala Hussain ◽

Annabelle Teng ◽

...

Keyword(s):

Lymph Nodes ◽

Gastric Adenocarcinoma ◽

Surgical Oncology ◽

Adverse Outcomes ◽

Clinical Staging ◽

National Cancer Database ◽

Term Survival ◽

Number Of Patients ◽

Propensity Matching

104 Background: The use of robotic technology in gastrointestinal surgical oncology is on the rise. We compared the outcomes of laparoscopic (LG) and robotic gastrectomies (RG) performed for gastric adenocarcinoma (GA) in the National Cancer Database (NCDB). Methods: The NCDB database was queried for patients ≥ 18 years old with stage I-III GA who underwent LG or RG. Propensity matching was performed between the two groups with regards to clinical staging, adjuvant treatment, demographics, and the extent of surgery. Results: A cohort of 1893 (1262-LG, 631-RG) patients was identified in a 2:1 propensity matching. Demographics and co-morbidities were similar between the groups. The clinical staging and the extent of the surgery were well matched. The rate of negative margin as well 30 and 90-day mortality was similar between the two cohorts. Outcomes with respect to readmission and length of stay were also similar (Table 1). Long-term survival was not significantly different between the two cohorts, with a median survival of 49 months for LG cohort and 56.1 months in the RG cohort (p=0.405). Also, lymph node (LN) positivity was similar between the two groups (40.1 % 42.8%, p= 0.278) However, the average number of LN sampled was significantly higher in the RA group compared to the LA group (19.6 vs 17.4, p<0.001). Similarly, the percentage of surgeries in which ≥ 15 LNs were sampled was also greater in the RG group compared to the LG group (63.9% vs 57.6%, p=0.010). Conclusions: Greater number of patients in the RG group achieved NCCN guideline of harvesting ≥ 15 lymph nodes for more accurate staging. RG may allow a greater harvest of lymph nodes without increasing short term adverse outcomes compared to LG. Long term outcomes in this well matched cohort appears comparable for both approaches.

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SO-7 The prognostic and predictive role of preoperative chemotherapy sensitivity in gastric adenocarcinoma: A study of national cancer database

Annals of Oncology ◽

10.1016/j.annonc.2021.05.031 ◽

2021 ◽

Vol 32 ◽

pp. S204-S205

Author(s):

L. Deng ◽

A. Groman ◽

C. Jiang ◽

S. Perimbeti ◽

E. Gabriel ◽

...

Keyword(s):

Gastric Adenocarcinoma ◽

Preoperative Chemotherapy ◽

National Cancer Database ◽

Chemotherapy Sensitivity ◽

Predictive Role

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Extensive Lymph Node Dissection Improves Survival among American Patients with Gastric Adenocarcinoma Treated Surgically: Analysis of the National Cancer Database

Journal of Gastric Cancer ◽

10.5230/jgc.2017.17.e36 ◽

2017 ◽

Vol 17 (4) ◽

pp. 319 ◽

Cited By ~ 9

Author(s):

Samer A. Naffouje ◽

George I. Salti

Keyword(s):

Lymph Node ◽

Gastric Adenocarcinoma ◽

Lymph Node Dissection ◽

National Cancer Database ◽

Node Dissection ◽

Extensive Lymph Node Dissection ◽

Extensive Lymph Node

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Comparative effectiveness of treatment modalities in non-metastatic gastric adenocarcinoma: a propensity score matching analysis of the National Cancer Database

BMJ Open Gastroenterology ◽

10.1136/bmjgast-2020-000483 ◽

2020 ◽

Vol 7 (1) ◽

pp. e000483

Author(s):

Afsaneh Barzi ◽

Dongyun Yang ◽

Anthony W Kim ◽

Manish A Shah ◽

Sarmad Sadeghi

Keyword(s):

Radiation Therapy ◽

Propensity Score ◽

Gastric Adenocarcinoma ◽

Neoadjuvant Chemoradiation ◽

Treatment Modalities ◽

Future Research ◽

World Population ◽

National Cancer Database ◽

Propensity Score Method ◽

Curative Surgery

BackgroundWhile addition of chemotherapy and radiation to surgery improves the outcomes of non-metastatic gastric adenocarcinoma (GAC), the best treatment strategy remains controversial.MethodsTo determine the effectiveness of different strategies in patients with curative surgery, we performed an analysis of GAC patients in National Cancer Database. Propensity score method was used to control for imbalances in the confounders. Overall survival (OS), the primary outcome, was analysed using Cox proportional hazard model and Kaplan-Meier curves.ResultsPatients diagnosed with GAC, from 2004 to 2013, were included in this analysis and grouped according to their treatment: surgery alone (15 184), chemoradiation in the neoadjuvant (6000) or adjuvant setting (7953), and perioperative chemotherapy (PCh; 3745) or adjuvant chemotherapy (ACh; 3000). Compared with surgery alone, all adjunctive therapies resulted in an improvement in OS; neoadjuvant chemoradiation (NACRT): HR 0.9 (95% CI: 0.84 to 0.97), PCh: HR 0.73 (95% CI: 0.68 to 0.79), adjuvant chemoradiation (ACRT): HR 0.71 (95% CI: 0.67 to 0.75), and ACh: HR 0.86 (95% CI: 0.8 to 0.93). Excluding patients with surgery only, we compared different strategies to PCh. In patients with distal GAC, ACRT resulted in improved OS, (HR 0.89; 95% CI: 0.796 to 0.996), p=0.042. In patients with proximal GAC, NACRT was inferior to PCh, HR 1.101 (95% CI: 1.006 to 1.204), p=0.036.ConclusionIn this real world population, addition of chemotherapy and radiation to surgery was associated with better OS. Radiation therapy may have a role in patients with distal GAC. Future research can elucidate patient, tumour, and treatment factors that necessitate the inclusion and sequence of radiation therapy in this population.

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Robotic Versus Laparoscopic Gastrectomy for Gastric Adenocarcinoma: Propensity-Matched Analysis

Surgical Innovation ◽

10.1177/1553350619868113 ◽

2019 ◽

Vol 27 (1) ◽

pp. 26-31 ◽

Cited By ~ 1

Author(s):

Sean Ryan ◽

Ashley Tameron ◽

Amy Murphy ◽

Lala Hussain ◽

Erik Dunki-Jacobs ◽

...

Keyword(s):

Gastric Adenocarcinoma ◽

Multivariable Analysis ◽

Adverse Outcomes ◽

Clinical Staging ◽

National Cancer Database ◽

Short Term ◽

Term Survival ◽

Propensity Matching ◽

Laparoscopic Assisted

Background. We compared the outcomes of laparoscopic-assisted (LA) and robotic-assisted (RA) gastrectomies performed for gastric adenocarcinoma in the National Cancer Database. Methods. The National Cancer Database was queried for patients 18 years old with stages I to III gastric adenocarcinoma who underwent LA or RA gastrectomy. Propensity matching was performed between the 2 groups with regard to clinical staging, adjuvant treatment, demographics, and the extent of surgery. Results. A cohort of 1893 (1262 = LA, 631 = RA) patients was identified in a 2:1 propensity matching. The groups were well matched. The rate of negative margin as well as 30- and 90-day mortality were similar between the 2 cohorts. Long-term survival was similar between the 2 groups (median survival 49.2 months in LA vs 56.2 months for RA, P = .405). However, the average number of lymph nodes (LNs) sampled was significantly higher in the RA group compared with the LA group (19.6 vs 17.4, P < .001). Similarly, the percentage of surgeries in which ≥15 LNs were sampled was also greater in the RA group compared with the LA group (63.9% vs 57.6%, P = .010). On multivariable analysis, having 15 LNs or more examined was associated with better survival (hazard ratio = 0.72, 95% confidence interval = 0.60-0.87, P < .001). Advanced age, nodal positivity, and advanced clinical stages were significantly associated with worse survival. Conclusions. RA gastrectomy may allow a greater harvest of LNs, and thus more accurate staging, without increasing short-term adverse outcomes compared with LA gastrectomy. Short-term and long-term outcomes in this well-matched cohort appear comparable for both approaches.

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