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COMPARING TREATMENT PATHWAYS IN GASTRIC CANCER STAGE: A NATIONAL CANCER DATA BASE ANALYSIS
Lacey Mead
*, Eden Crowsey, Manuel Molina
General Surgery Resident, Lakeland Regional Medical Center Inc, Lakeland, FL
Introduction: The mainstay treatment of gastric cancer is a combination of neoadjuvant chemotherapy, surgery, then adjuvant chemotherapy for T2 stages and higher. Recent observation suggests a detriment with utilizing neoadjuvant chemotherapy, such as possible upstaging, digression of patient fitness, and surgical complications. Our goal is to utilize the National Center Data Base in order to assess whether there is a null or deleterious impact of neoadjuvant chemotherapy in T2 stage of gastric cancer.
Method: We evaluated recent National Cancer Data Base (NCBD) population from 2013-2021. We compared staging with 30 and 90 day mortality of gastric cancers with those who received neoadjuvant, adjuvant, no chemotherapy and no surgery/chemotherapy for T2 stages. We assessed upstaging between neoadjuvant therapy and surgery, or any progression/recurrence of disease. Statistical analysis with chi square and risk regression compared groups. A p-value of <0.05 will be deemed as statically significant.
Results: 13304 patients included in the 2021 NCDB stomach cancer dataset in stage two cancer at diagnosis and had complete data for up to 90-day mortality. There were 7108 were neoadjuvant and 2636 were adjuvant. Patients who received neoadjuvant chemotherapy were 4 times less likely to survive 90 days from their cancer diagnosis relative to patients who had adjuvant chemotherapy,
RR=0.24, 95% CI [2.86, 5.80]. When patients were treated with chemotherapy alone they were 9.5 times more likely to survive 90 days relative to patients who received neither surgery or chemotherapy, RR=9.49,
95% CI [3.78, 23.86] and patients who were treated with only surgery were less likely to survive 90 relative to patients who received no treatment at all, RR=.70, 95% CI [0.53, 0.94].
Conclusion: Based on the NCDB data base, neoadjuvant chemotherapy has 4 times less likely to survive to 90 days compared to adjuvant chemotherapy in T2 gastric cancer. This may suggest a needed variance in management pathways for these patients.
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