Annals of surgical oncology · 2025
Trends in Clinicopathologic and Treatment Outcomes in Patients with Gastric Adenocarcinoma in the United States Between 2004 and 2021.
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Esparham Ali, Whittington Jennifer, Agriantonis George, Shafaee Zahra
Аннотация
BACKGROUND: Gastric adenocarcinoma (GAC) continues to be a significant global health challenge with shifting demographics, treatment approaches, and outcomes. Although innovations have improved care, there is still a lack of comprehensive, real-world, population-level data examining these changes over time in the USA.
METHODS: We carried out a retrospective cohort study using the National Cancer Database from 2004 to 2021 to examine trends in patient demographics, treatment approaches, and clinical outcomes among 177,069 patients with GAC. The study was divided into three periods: 2004-2009, 2010-2015, and 2016-2021.
RESULTS: The use of laparoscopic and robotic approaches, neoadjuvant systemic therapy, and multi-agent chemotherapy has significantly increased, whereas rates of open surgery, adjuvant treatment, and single-agent regimens have declined. The use of immunotherapy rose significantly, from 0.1 to 10%. Surgical quality has improved, indicated by a higher number of lymph nodes retrieved. There were significant decreases in readmission rates, reductions in 30-day and 90-day mortality, and shorter lengths of stay. Although more patients are presenting with metastatic disease, the 3-year overall survival rate has increased significantly from 13.3 to 23.1%. Additionally, overall survival improved significantly across the periods, with median survival increasing from 12.4 months in P1 to 15.6 months in P2 and 17.9 months in P3 (p < 0.001).
CONCLUSION: This national analysis highlights significant advancements in GAC management between 2004 and 2021, such as the adoption of minimally invasive surgery and advanced systemic therapies. These changes have led to better surgical quality and higher survival rates.
METHODS: We carried out a retrospective cohort study using the National Cancer Database from 2004 to 2021 to examine trends in patient demographics, treatment approaches, and clinical outcomes among 177,069 patients with GAC. The study was divided into three periods: 2004-2009, 2010-2015, and 2016-2021.
RESULTS: The use of laparoscopic and robotic approaches, neoadjuvant systemic therapy, and multi-agent chemotherapy has significantly increased, whereas rates of open surgery, adjuvant treatment, and single-agent regimens have declined. The use of immunotherapy rose significantly, from 0.1 to 10%. Surgical quality has improved, indicated by a higher number of lymph nodes retrieved. There were significant decreases in readmission rates, reductions in 30-day and 90-day mortality, and shorter lengths of stay. Although more patients are presenting with metastatic disease, the 3-year overall survival rate has increased significantly from 13.3 to 23.1%. Additionally, overall survival improved significantly across the periods, with median survival increasing from 12.4 months in P1 to 15.6 months in P2 and 17.9 months in P3 (p < 0.001).
CONCLUSION: This national analysis highlights significant advancements in GAC management between 2004 and 2021, such as the adoption of minimally invasive surgery and advanced systemic therapies. These changes have led to better surgical quality and higher survival rates.