Multimodality treatment (MMT) and outcomes of gastric adenocarcinoma (GC) in National Cancer DataBase(NCDB)

Objective To analyze the patterns of care and survival of cutaneous angiosarcomas of the head and neck. Study Design Retrospective cohort study. Setting National Cancer Database. Methods The National Cancer Database was queried to select patients with cutaneous angiosarcoma of the head and neck between 2004 and 2015. For survival analysis, patients were included only if they received definitive treatment and complete data. Prognostic factors were analyzed by univariate and multivariable Cox regression. Results We identified 693 patients diagnosed with head and neck angiosarcomas during the study period. The majority were male (n = 489, 70.6%) and elderly (median, 77 years). A total of 421 patients (60.8%) met the criteria for survival analyses. These patients were treated with surgery and radiation (n = 178, 42.3%), surgery alone (n = 138, 32.8%), triple-modality therapy (n = 48, 11.4%), surgery and chemotherapy (n = 29, 6.9%), and chemoradiation (n = 28, 6.7%). With a median follow-up of 29 months, the 3-year survival was 50.1%. Patients undergoing surgery had better median survival than those who did not (38.1 vs 21.0 months, P = .04). Age, comorbidity, tumor size, and surgical margins were significant factors in univariate analyses. On multivariable analysis, age ≥75 years (hazard ratio, 2.65; 95% CI, 1.80-3.88; P < .001) and positive margins (hazard ratio, 1.91; 95% CI, 1.44-2.51; P < .001) predicted worse overall survival. Conclusion Angiosarcoma of head and neck is a rare malignancy that affects the elderly. Surgical treatment with negative margins is associated with improved survival. Even with curative-intent multimodality treatment, the survival of patients aged ≥75 years is limited.

Download Full-text

Pathologic Complete Response Following Neoadjuvant Therapy for Gastric Adenocarcinoma: A National Cancer Database Analysis on Incidence, Predictors, and Outcomes

The American Surgeon ◽

10.1177/0003134820972083 ◽

2020 ◽

pp. 000313482097208

Author(s):

Christof Kaltenmeier ◽

Alison Althans ◽

Maria Mascara ◽

Ibrahim Nassour ◽

Sidrah Khan ◽

...

Keyword(s):

Gastric Cancer ◽

Neoadjuvant Therapy ◽

Gastric Adenocarcinoma ◽

Survival Rates ◽

Pathologic Complete Response ◽

Tumor Grade ◽

Complete Response ◽

Neoadjuvant Chemoradiation ◽

National Cancer Database ◽

The Impact

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.

Download Full-text

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.

Download Full-text

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

Download Full-text

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

Download Full-text

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

Journal of Surgical Research ◽

10.1016/j.jss.2019.07.073 ◽

2020 ◽

Vol 245 ◽

pp. 619-628

Author(s):

Benjamin W. Fisher ◽

Marcus Fluck ◽

Katelyn Young ◽

Mohsen Shabahang ◽

Joseph Blansfield ◽

...

Keyword(s):

Gastric Adenocarcinoma ◽

National Cancer Database ◽

Urgent Surgery

Download Full-text

Outcomes of octogenarians with esophageal cancer: an analysis of the National Cancer Database

Diseases of the Esophagus ◽

10.1093/dote/doy128 ◽

2018 ◽

Vol 32 (10) ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

C T Bakhos ◽

A C Salami ◽

L R Kaiser ◽

R V Petrov ◽

A E Abbas

Keyword(s):

Esophageal Cancer ◽

Postoperative Mortality ◽

Multimodality Treatment ◽

Tumor Stage ◽

Multimodality Therapy ◽

National Cancer Database ◽

Term Survival ◽

Younger Patients ◽

Long Term Survival

SUMMARYThe optimal treatment of esophageal cancer in octogenarians is controversial. While the safety of esophagectomy has been demonstrated in elderly patients, surgery and multimodality therapy are still offered to a select group. Additionally, the long-term outcomes in octogenarians have not been thoroughly compared to those in younger patients. We sought to compare the outcomes of esophageal cancer treatment between octogenarians and non-octogenarians in the National Cancer Database (2004–2014). The major endpoints were early postoperative mortality and long-term survival. A total of 107,921 patients were identified [octogenarian—16,388 (15.2%)]. Compared to non-octogenarians, octogenarians were more likely to be female, of higher socioeconomic status, and had more Charlson comorbidities (p < 0.001 for all). Octogenarians were significantly less likely to undergo esophagectomy (11.5% vs. 33.3%; p < 0.001) and multimodality therapy (2.0% vs. 18.5%; p < 0.001), a trend that persisted following stratification by tumor stage and Charlson comorbidities. Both 30-day and 90-day mortality were higher in the octogenarian group, even after multivariable adjustment (p ≤ 0.001 for both). Octogenarians who underwent multimodality therapy had worse long-term survival when compared to younger patients, except for those with stage III tumors and no comorbidities (HR: 1.29; p = 0.153). Within the octogenarian group, postoperative mortality was lower in academic centers, and the long-term survival was similar between multimodality treatment and surgery alone (HR: 0.96; p = 0.62). In conclusion, octogenarians are less likely to be offered treatment irrespective of tumor stage or comorbidities. Although octogenarians have higher early mortality and poorer overall survival compared to younger patients, outcomes may be improved when treatment is performed at academic centers. Multimodality treatment did not seem to confer a survival advantage compared to surgery alone in octogenarians, and more prospective studies are necessary to better elucidate the optimal treatment in this patient population.

Download Full-text

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.

Download Full-text