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Claassen YHM, Dikken JL, Hartgrink HH, de Steur WO, Slingerland M, Verhoeven RHA, van Eycken E, de Schutter H, Johansson J, Rouvelas I, Johnson E, Hjortland GO, Jensen LS, Larsson HJ, Allum WH, Portielje JEA, Bastiaannet E, van de Velde CJH. North European comparison of treatment strategy and survival in older patients with resectable gastric cancer: A EURECCA upper gastrointestinal group analysis. Eur J Surg Oncol 2018; 44:1982-1989. [PMID: 30343998 DOI: 10.1016/j.ejso.2018.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 09/14/2018] [Accepted: 09/21/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND As older gastric cancer patients are often excluded from randomized clinical trials, the most appropriate treatment strategy for these patients remains unclear. The current study aimed to gain more insight in treatment strategies and relative survival of older patients with resectable gastric cancer across Europe. METHODS Population-based cohorts from Belgium, Denmark, The Netherlands, Norway, and Sweden were combined. Patients ≥70 years with resectable gastric cancer (cT1-4a, cN0-2, cM0), diagnosed between 2004 and 2014 were included. Resection rates, administration of chemotherapy (irrespective of surgery), and relative survival within a country according to stage were determined. RESULTS Overall, 6698 patients were included. The percentage of operated patients was highest in Belgium and lowest in Sweden for both stage II (74% versus 56%) and stage III disease (57% versus 25%). For stage III, chemotherapy administration was highest in Belgium (44%) and lowest in Sweden (2%). Three year relative survival for stage I, II, and III disease in Belgium was 67.8% (95% CI:62.8-72.6), 41.2% (95% CI:37.3-45.2), 17.8% (95% CI:12.5-24.0), compared with 56.7% (95% CI:51.5-61.7), 31.3% (95% CI:27.6-35.2), 8.2% (95% CI:4.4-13.4) in Sweden. There were no significant differences in treatment strategies of patients with stage I disease. CONCLUSION Substantial treatment differences are observed across North European countries for patients with stages II and III resectable gastric cancer aged 70 years or older. In the present comparison, treatment strategies with a higher proportion of patients undergoing surgery seemed to be associated with higher survival rates for patients with stages II or III disease.
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Affiliation(s)
- Y H M Claassen
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
| | - J L Dikken
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - H H Hartgrink
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - W O de Steur
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - M Slingerland
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - R H A Verhoeven
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), the Netherlands
| | | | | | - J Johansson
- Department of Surgery, Lund University, Lund, Sweden
| | - I Rouvelas
- Department of Clinical Science, Intervention and Technology (CLINTEC), Division of Surgery, Karolinska Institute, Stockholm, Sweden; Section of Esophagogastric Surgery, Centre for Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - E Johnson
- Institute of Clinical Medicine, University of Oslo, Norway; Department of Gastroenterological and Pediatric Surgery, Oslo University Hospital, Oslo, Norway
| | - G O Hjortland
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - L S Jensen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - H J Larsson
- The Danish National Registries, a National Quality Improvement Programme (RKKP), Aarhus, Denmark
| | - W H Allum
- Department of Surgery, Royal Marsden NHS Foundation Trust, London, Great Britain, UK
| | - J E A Portielje
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - E Bastiaannet
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands; Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands
| | - C J H van de Velde
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
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Claassen YHM, Bastiaannet E, Hartgrink HH, Dikken JL, de Steur WO, Slingerland M, Verhoeven RHA, van Eycken E, de Schutter H, Lindblad M, Hedberg J, Johnson E, Hjortland GO, Jensen LS, Larsson HJ, Koessler T, Chevallay M, Allum WH, van de Velde CJH. International comparison of treatment strategy and survival in metastatic gastric cancer. BJS Open 2018; 3:56-61. [PMID: 30734016 PMCID: PMC6354181 DOI: 10.1002/bjs5.103] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 08/06/2018] [Indexed: 12/27/2022] Open
Abstract
Background In the randomized Asian REGATTA trial, no survival benefit was shown for additional gastrectomy over chemotherapy alone in patients with advanced gastric cancer with a single incurable factor, thereby discouraging surgery for these patients. The purpose of this study was to evaluate treatment strategies for patients with metastatic gastric cancer in daily practice in five European countries, along with relative survival in each country. Methods Nationwide population‐based data from Belgium, Denmark, the Netherlands, Norway and Sweden were combined. Patients with primary metastatic gastric cancer diagnosed between 2006 and 2014 were included. The proportion of gastric resections performed and the administration of chemotherapy (irrespective of surgery) within each country were determined. Relative survival according to country was calculated. Results Overall, 15 057 patients with gastric cancer were included. The proportion of gastric resections varied from 8·1 per cent in the Netherlands and Denmark to 18·3 per cent in Belgium. Administration of chemotherapy was 39·2 per cent in the Netherlands, compared with 63·2 per cent in Belgium. The 6‐month relative survival rate was between 39·0 (95 per cent c.i. 37·8 to 40·2) per cent in the Netherlands and 54·1 (52·1 to 56·9) per cent in Belgium. Conclusion There is variation in the use of gastrectomy and chemotherapy in patients with metastatic gastric cancer, and subsequent differences in survival.
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Affiliation(s)
- Y H M Claassen
- Department of Surgery Leiden University Medical Centre Leiden the Netherlands
| | - E Bastiaannet
- Department of Surgery Leiden University Medical Centre Leiden the Netherlands.,Department of Medical Oncology Leiden University Medical Centre Leiden the Netherlands
| | - H H Hartgrink
- Department of Surgery Leiden University Medical Centre Leiden the Netherlands
| | - J L Dikken
- Department of Surgery Leiden University Medical Centre Leiden the Netherlands
| | - W O de Steur
- Department of Surgery Leiden University Medical Centre Leiden the Netherlands
| | - M Slingerland
- Department of Medical Oncology Leiden University Medical Centre Leiden the Netherlands
| | - R H A Verhoeven
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL) Utrecht the Netherlands
| | | | | | - M Lindblad
- Department of Surgical Gastroenterology Karolinska University Hospital Stockholm Sweden
| | - J Hedberg
- Department of Surgical Science Uppsala University Uppsala Sweden
| | - E Johnson
- Department of Gastroenterological and Paediatric Surgery Oslo University Hospital Oslo Norway.,Department of Oncology Oslo University Hospital Oslo Norway
| | - G O Hjortland
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - L S Jensen
- Department of Surgery Aarhus University Hospital Aarhus Denmark
| | - H J Larsson
- The Danish National Registries, National Quality Improvement Programme (RKKP) Aarhus Denmark
| | - T Koessler
- Department of Medical Oncology Geneva University Hospital Geneva Switzerland
| | - M Chevallay
- Department of Surgery Geneva University Hospital Geneva Switzerland
| | - W H Allum
- Department of Surgery Royal Marsden NHS Foundation Trust London UK
| | - C J H van de Velde
- Department of Surgery Leiden University Medical Centre Leiden the Netherlands
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