Understanding Factors Leading to Surgical Attrition for "Resectable" Gastric Cancer.
Publication/Presentation Date
7-1-2023
Abstract
OBJECTIVES: We used a novel combined analysis to evaluate various factors associated with failure to surgical resection in non-metastatic gastric cancer.
METHODS: We identified factors associated with the receipt of surgery in publicly available clinical trial data for gastric cancer and in the National Cancer Database (NCDB) for patients with stages I-III gastric adenocarcinoma. Next, we evaluated variable importance in predicting the receipt of surgery in the NCDB.
RESULTS: In published clinical trial data, 10% of patients in surgery-first arms did not undergo surgery, mostly due to disease progression and 15% of patients in neoadjuvant therapy arms failed to reach surgery. Effects related to neoadjuvant administration explained the increased attrition (5%). In the NCDB, 61.7% of patients underwent definitive surgery. In a subset of NCDB patients resembling those enrolled in clinical trials (younger, healthier, and privately insured patients treated at high-volume and academic centers) the rate of surgery was 79.2%. Decreased likelihood of surgery was associated with advanced age (OR 0.97, p < 0.01), Charlson-Deyo score of 2+ (OR 0.90, p < 0.01), T4 tumors (OR 0.39, p < 0.01), N+ disease (OR 0.84, p < 0.01), low socioeconomic status (OR 0.86, p = 0.01), uninsured or on Medicaid (OR 0.58 and 0.69, respectively, p < 0.01), low facility volume (OR 0.64, p < 0.01), and non-academic cancer programs (OR 0.79, p < 0.01).
CONCLUSION: Review of clinical trials shows attrition due to unavoidable tumor and treatment factors (~ 15%). The NCDB indicates non-medical patient and provider characteristics (i.e., age, insurance status, facility volume) associated with attrition. This combined analysis highlights specific opportunities for improving potentially curative surgery rates.
Volume
30
Issue
7
First Page
4207
Last Page
4216
ISSN
1534-4681
Published In/Presented At
Kakish, H. H., Ahmed, F. A., Pei, E., Dong, W., Elshami, M., Ocuin, L. M., Rothermel, L. D., Ammori, J. B., & Hoehn, R. S. (2023). Understanding Factors Leading to Surgical Attrition for "Resectable" Gastric Cancer. Annals of surgical oncology, 30(7), 4207–4216. https://doi.org/10.1245/s10434-023-13469-5
Disciplines
Medicine and Health Sciences
PubMedID
37046129
Department(s)
Department of Surgery, Lehigh Valley Topper Cancer Institute
Document Type
Article