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Upper Gastrointestinal (lips to ileocecal valve, including esophagus and stomach)

E465: Evolving Landscapes in Gastric Cancer Treatment Over a Decade

Introduction: The treatment of gastric cancer has undergone significant changes with the institution of perioperative chemotherapy. Improved chemotherapy regimens have led to significantly improved overall survival. We aimed to evaluate the shifts in  treatment trends for stage I, II, and III gastric cancer using the National Cancer Database (NCDB).

Methods: We queried the NCDB from 2011-2020 for patients diagnosed with stage I (n = 39,449), II (n =  24,346), and III (n = 30,153) gastric cancer. We evaluated the trends of surgery only (SO), chemotherapy and surgery (CS), and chemotherapy, radiation, and surgery (CRS) by year. We examined demographic factors: age, insurance status, race, distance from hospital, hospital type, and comorbidity score and their relationship to treatment modality. Trend analysis and chi-squared tests were performed where appropriate.

Results: From 2011 to 2020, utilization of SO for gastric cancer decreased significantly for stage II (24.4% to 19.2%, p< 0.05) and stage III (18.5% to 10.6%, p< 0.05). During this same time period, the use of CS increased for stage I ( 8.1% to 11.4%, p< 0.05),  stage II (19% to 32%, p< 0.05),  and stage III (20.6% to 27%, p< 0.05). Additionally, the use of CRS decreased stage III (32.2% to 22.1%, p< 0.05).   For stage I gastric cancer, patients >60 years old underwent less SO when compared to patients < 60 years old (17% vs. 45.8%, p < 0.0002). Academic centers had a significant trend for stage II with increased use of CS( 25% to 33%, p< 0.05) and decreased SCR (27% to 12%, p< 0.05). There was also increased use of CS (24% to 31%, p< 0.05) for stage III. Academic centers did not have a significant trend for stage III SCR,SO, stage II SO, and stage I SO, SCR, and SC.  Community centers only had a significant trend of decreased SO (21% to 13%, p< 0.05) for stage III patients. Insurance, race, and distance did not have a significant impact in the treatment of gastric cancers. For stage II and III gastric cancer, treatment with CRS and CS decreased with higher Charlson comorbidity scores (2/3+) compared to lower scores (0/1) ( p < 0.0001).

Conclusions: The treatment of stage I to III gastric cancers has evolved over the last 10 years, with increased use of CS and decreasing SO and CRS. Age and comorbidity score have a significant relationship with the usage of different treatment modalities. Academic centers appear to have significant trends for increased use of CS for stage II and stage III patients. Community centers have a trend of decreased SO in stage III patients.  A more detailed multivariate analysis will allow us to gain more insight in the different trends that we observed in this review.

Learning Objectives:

  • Upon completion, participants will be able to see the trend in gastric cancer treatment over the last ten years.
  • Upon completion, participants will be able to see how demographic factors impact the treatment trend of gastric cancer.
  • Upon completion, participants will be able to see how hospital type such as academic and community impact the treatment trend of gastric cancer.

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