Trends in multimodality therapy for gastric cancer post-MAGIC.

148 Background: Althoughmultimodality therapy (MMT) is recommended for most patients with resectable gastric cancer, no single approach has been established as standard. As such, little is known about current national practice patterns and MMT treatment sequencing for patients with gastric cancer. Methods: This was a retrospective cohort study of ≥ T2 and/or node positive gastric cancer patients treated with MMT using the National Cancer Database (2006-2012). Patients were categorized based on type of MMT (chemotherapy, concurrent chemoradiation (cXRT), or both chemotherapy and cXRT) and treatment sequence (preoperative, postoperative, or perioperative). Accuracy of pre-treatment clinical nodal staging was ascertained by comparison to pathologic nodal staging in patients treated with upfront surgery. Multivariable Cox regression was used to evaluate the association between overall risk of death and MMT type and sequence. Results: Among 4,857 patients, 14.1% were treated perioperatively, 48.0% preoperatively, and 37.9% postoperatively. Rates of chemotherapy, cXRT, and both chemotherapy and cXRT were 32.1%, 53.4%, and 14.5%. Among patients treated with upfront surgery, sensitivity, specificity, PPV, and NPV of clinical nodal staging were 70.7%, 88.8%, 92.1%, and 62.2%, respectively. Over the study period, use of cXRT decreased (61.8% 2006 vs 52.0% 2012; trend test, p < 0.001) while use of chemotherapy increased (23.6% vs 35.7%; trend test, p < 0.001) and use of both chemotherapy and cXRT did not change. There was an increase in the use of perioperative treatment (8.1% vs 17.4%; trend test, p < 0.001) while postoperative treatment decreased (44.4% vs 31.1%; trend test, p < 0.001). After multivariable modeling, neither type of MMT nor treatment sequence was associated with risk of death. Conclusions: Although current national practice patterns favor pre- and perioperative treatment, one third of patients were treated with upfront surgery. Survival was not associated with MMT type or sequence. However, given the high false negative rate of clinical nodal staging and high non-completion rate of postoperative treatment (50% in MAGIC trial), efforts to improve gastric cancer outcomes should focus on increasing use of preoperative therapy.

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Pathologic nodal response in gastric cancer: Do all patients need adjuvant therapy?

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.107 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 107-107

Author(s):

Brandon George Smaglo ◽

Yvonne Sada ◽

Hop Sanderson Tran Cao ◽

Mehmet Akce ◽

Henry Mok ◽

...

Keyword(s):

Gastric Cancer ◽

Adjuvant Therapy ◽

Median Survival ◽

Cox Regression ◽

Multivariable Analysis ◽

Treatment Sequence ◽

Disease Response ◽

Risk Of Death ◽

Pre Treatment ◽

Chemotherapy Patients

107 Background: Recent data from the MAGIC trial show that pathologically positive lymph nodes (ypN+) despite neoadjuvant (NA) chemotherapy are associated with poorer survival. Although the use of NA therapy has increased, pathologic disease response to multimodality therapy (MMT) and its impact on outcome have not been well-defined. Methods: This retrospective cohort study of the National Cancer Database included patients with cN+ gastric cancer who underwent NA therapy followed by surgical resection between 2006 and 2012. Patients were categorized by NA treatment (chemotherapy or concurrent chemoradiation). Pre-treatment clinical (cN) and pathologic nodal staging (ypN) were used to determine downstaging rates from cN+ to ypN0. The association between overall risk of death and NA treatment, nodal response, and the use of adjuvant therapy was evaluated with multivariable Cox regression. Results: Among 1,489 patients with cN+ gastric cancer receiving NA therapy, 45.5% were treated with chemotherapy and 54.5% with chemoradiation. Rates of nodal downstaging were 29.9% for chemotherapy and 45.4% for chemoradiation. On multivariable analysis, treatment sequence and type were not associated with risk of death. Median survival was significantly lower in patients with ypN+ compared to those with ypN0 disease (27.7 vs 79.7 months; log-rank, p < 0.001).Among patients with ypN+ disease (n = 918), median survival was greater if adjuvant therapy was received (32.6 months vs. 25.3 months, log-rank, p < 0.001); adjuvant therapy was associated with a 19% decreased risk of death (Hazard Ratio [HR] 0.81; 95% CI 0.66-0.99), with further reduction among those who underwent a margin negative resection (HR 0.73; 95% CI 0.58-0.92). In patients with ypN0, adjuvant therapy was not associated with a lower risk of death. Conclusions: Over one third of node-positive gastric cancers demonstrated pathologic nodal downstaging with NA treatment, with chemoradiation yielding a higher response than chemotherapy. Patients with ypN+ had worse survival, and appeared to benefit from adjuvant therapy. Future gastric cancer trials should better define the role for NA chemoradiation and help individualize the use of adjuvant therapy based on nodal response.

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Faculty Opinions recommendation of Adult anterior urethral strictures: a national practice patterns survey of board certified urologists in the United States.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1072116.525107 ◽

2007 ◽

Author(s):

Reynaldo Gomez

Keyword(s):

United States ◽

Practice Patterns ◽

The United States ◽

Urethral Strictures ◽

National Practice

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Cardiac Risk Assessment in Liver Transplant Candidates: A Survey of National Practice Patterns

Liver Transplantation ◽

10.1002/lt.26307 ◽

2021 ◽

Author(s):

Pranab M. Barman ◽

Ryan M. Chadha ◽

Lisa B. VanWagner

Keyword(s):

Risk Assessment ◽

Liver Transplant ◽

Practice Patterns ◽

Cardiac Risk ◽

Cardiac Risk Assessment ◽

Transplant Candidates ◽

National Practice

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A 15-Year Review of Clinical Practice Patterns and Evidence-Based Medicine in Carpometacarpal Joint Arthroplasty

Hand ◽

10.1177/15589447211060421 ◽

2021 ◽

pp. 155894472110604

Author(s):

Nikhil D. Shah ◽

Selcen Yuksel ◽

Daniel C. Sasson ◽

Aaron M. Kearney ◽

Michael W. Neumeister ◽

...

Keyword(s):

Evidence Based Medicine ◽

Practice Patterns ◽

Joint Arthroplasty ◽

Thrombosis Prophylaxis ◽

Evidence Based ◽

Process Data ◽

Vein Thrombosis ◽

Based Medicine ◽

National Practice ◽

Cmc Joint

Background: The purpose of this study was to help understand national practice patterns in carpometacarpal (CMC) arthroplasty and how they have evolved with evidence-based recommendations over the past 15 years. Methods: The American Board of Plastic Surgery (ABPS) started collecting practice data on primary CMC joint arthroplasty in 2006 as a portion of its continuous certification (CC) process. Data on primary CMC arthroplasty from May 2006 through December 2013 were reviewed and compared to those from January 2014 to March 2020. National practice trends observed in these data were evaluated. Comprehensive evidence-based medicine reviews published in 2008, 2011, 2013, and 2017 were reviewed alongside the CC data. Results: In all, 570 primary CMC joint arthroplasty cases were included from May 2006 to March 2020. The average age at the time of repair was 62 years and the patient population was predominantly female (79%). Most cases were done under general anesthesia (69%), and there was an increase in the use of regional anesthesia with nerve block when our 2 cohorts were compared (27% vs 37%; P = .020). A trapezium excision with flexor carpi radialis tendon ligament reconstruction was the most popular technique (72%) and an increase in the use of simple trapeziectomy was observed (6% vs 14%; P = .001). One-third of patients did not receive any form of deep vein thrombosis prophylaxis. Conclusions: The ABPS CC data provide a databank that allows for direct observation of national practice trends and sheds light on potential avenues for improvement in patient care.

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ADDUCTOR POLLICIS MUSCLE THICKNESS AND PREDICTION OF POSTOPERATIVE MORTALITY IN PATIENTS WITH STOMACH CANCER

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/0102-672020180001e1340 ◽

2018 ◽

Vol 31 (1) ◽

Cited By ~ 6

Author(s):

Aline Kirjner POZIOMYCK ◽

Oly Campos CORLETA ◽

Leandro Totti CAVAZZOLA ◽

Antonio Carlos WESTON ◽

Edson Braga LAMEU ◽

...

Keyword(s):

Gastric Cancer ◽

Stomach Cancer ◽

Nutritional Assessment ◽

Postoperative Mortality ◽

Muscle Thickness ◽

Adductor Pollicis ◽

Dominant Hand ◽

Adductor Pollicis Muscle ◽

Risk Of Death ◽

Muscle Compartment

ABSTRACT Background: Malnutrition is very prevalent in patients with gastric cancer and increases the risk of morbidity and mortality. Adductor pollicis muscle thickness (APMT) appears as an important objective, quick, inexpensive and noninvasive measure to assess the muscle compartment Aim: To compare APMT and other nutritional assessment methods and to correlate these methods with postoperative mortality Methods: Forty-four patients, 29 men and 15 women, mean age of 63±10.2 and ranging from 34-83 years, who underwent nine (20.5%) partial and 34 (77.3%) total gastrectomies due to stomach cancer (stage II to IIIa) were preoperatively assessed by Patient Generated Subjective Global Assessment (PG-SGA), anthropometry and laboratorial profile Results: APMT better predicted death (p<0.001) on both, dominant and non-dominant hand, and well correlated with albumin (p=0.039) and PG-SGA (p=0.007) Conclusion: APMT clearly allowed to determine malnutrition and to predict risk of death in patients with gastric cancer.

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Corrigendum to: National practice patterns for lymph node irradiation in 197,000 men receiving external beam radiotherapy for localized prostate cancer

Urologic Oncology Seminars and Original Investigations ◽

10.1016/j.urolonc.2019.07.003 ◽

2019 ◽

Vol 37 (8) ◽

pp. 563

Author(s):

Adam B. Weiner ◽

Oliver S. Ko ◽

Alec Zhu ◽

Daniel E. Spratt ◽

Jim C. Hu ◽

...

Keyword(s):

Prostate Cancer ◽

Lymph Node ◽

Practice Patterns ◽

External Beam Radiotherapy ◽

Localized Prostate Cancer ◽

External Beam ◽

Lymph Node Irradiation ◽

National Practice

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Poor compliance with perioperative treatment in patients with resectable gastric cancer

Annals of Oncology ◽

10.1093/annonc/mdx261.013 ◽

2017 ◽

Vol 28 ◽

pp. iii17

Author(s):

Margreet van Putten ◽

Valery Lemmens ◽

Hanneke van Laarhoven ◽

Hans Pruijt ◽

Grard Nieuwenhuijzen ◽

...

Keyword(s):

Gastric Cancer ◽

Poor Compliance ◽

Perioperative Treatment ◽

Resectable Gastric Cancer

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Geographic variation in surgical practice patterns and outcomes for resected nonmetastatic gastric cancer in Ontario

Current Oncology ◽

10.3747/co.25.3953 ◽

2018 ◽

Vol 25 (5) ◽

Cited By ~ 6

Author(s):

A. L. Mahar ◽

A. El-Sedfy ◽

M. Dixon ◽

M. Siddiqui ◽

M. Elmi ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Nodes ◽

Practice Patterns ◽

Early Stage ◽

Primary Tumour ◽

Disease Stage ◽

Resection Margins ◽

Local Health ◽

Surgical Practice ◽

Tumour Location

BackgroundGastrectomy with negative resection margins and adequate lymph node dissection is the cornerstone of curative treatment for gastric cancer (gc). However, gastrectomy is a complex and invasive operation with significant morbidity and mortality. Little is known about surgical practice patterns or short- and long-term outcomes in early-stage gc in Canada.MethodsWe undertook a population-based retrospective cohort study of patients with gc diagnosed between 1 April 2005 and 31 March 2008. Chart review provided clinical and operative details such as disease stage, primary tumour location, surgical approach, operation, lymph nodes, and resection margins. Administrative data provided patient demographics, geography, and vital status. Variations in treatment and outcomes were compared for 14 local health integration networks. Descriptive statistics and log-rank tests were used to examine geographic variation.ResultsWe identified 722 patients with nonmetastatic resected gc. We documented significant provincial variation in case mix, including primary tumour location, stage at diagnosis, and tumour grade. Short-term surgical outcomes varied across the province. The percentage of patients with 15 or fewer lymph nodes removed and examined varied from 41.8% to 73.8% (p = 0.02), and the rate of positive surgical margins ranged from 15.2% to 50.0% (p = 0.002). The 30-day surgical mortality rates did not vary statistically significantly across the province (p = 0.13); however, rates ranged from 0% to 16.7%. Overall 5-year survival was 44% and ranged from 31% to 55% across the province.ConclusionsThis cohort of patients with resected stages i–iii gc is the largest analyzed in Canada, providing important historical information about treatment outcomes. Understanding the causes of regional variation will support interventions aiming to improve gc operative outcomes in the cancer system.

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