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Patterns of Care for Radiotherapy in the Neoadjuvant and Adjuvant Treatment of Gastric Cancer: A Twelve-Year Nationwide Cohort Study in Korea

박은철|신재용|김경환|최영|금기창|김효송|금웅섭|장지석
대한암학회 (Korean Cancer Association)|2018.01|Cancer Research and Treatment|제50권 제1호|pp. 118-128

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키워드

ChemoradiotherapyStomach neoplasmsAdjuvant radiotherapyPhysicians’ practice patterns
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초록

Purpose Although Korea has the highest incidence of gastric cancer worldwide and D2-lymphadenectomies are routinely performed, radiotherapy (RT) practice patterns have not been well studied. Therefore, we examined RT usage trends for neoadjuvant/adjuvant patients and identified factors associated with RT. We also examined survival benefits and net medical cost advantages of adding RT. Materials and Methods Patients diagnosed with gastric cancer who underwent gastrectomy from 2002-2013 were identified using National Health Insurance Service-National Sample Cohort. Results Annually, 30.9 cases per 100,000 population in crude rate underwent gastrectomy in 230 hospitals and 49.8% received neoadjuvant/adjuvant therapy in 182 hospitals. For neoadjuvant/ adjuvant patients, postoperative chemo-RT was administered in 4% of cases in 26 hospitals. No significant trends regarding treatment type were observed over time. Having undergone RT was inversely associated with being ! 60 years old and having a low income. Having undergone RT was positively related to having a Charlson comorbidity index ! 4, hospital location and hospital volume (! 2,000 beds). Significant portions of patients treated with RT in this nation (52%) were concentrated in one large-volume hospital. Use of RT linked to increased cost of primary treatment, yet not to reduced overall medical expense. RT did not influence both on overall and disease-specific survivals after adjusting for potential confounders (p > 0.05). Conclusion RT was uncommonly utilized as adjuvant or neoadjuvant treatment by physicians in Korea. Despite intrinsic drawback in this data, we did not find either survival benefit or net medical cost advantage by adding RT in adjuvant treatment.

Abstract

Purpose Although Korea has the highest incidence of gastric cancer worldwide and D2-lymphadenectomies are routinely performed, radiotherapy (RT) practice patterns have not been well studied. Therefore, we examined RT usage trends for neoadjuvant/adjuvant patients and identified factors associated with RT. We also examined survival benefits and net medical cost advantages of adding RT. Materials and Methods Patients diagnosed with gastric cancer who underwent gastrectomy from 2002-2013 were identified using National Health Insurance Service-National Sample Cohort. Results Annually, 30.9 cases per 100,000 population in crude rate underwent gastrectomy in 230 hospitals and 49.8% received neoadjuvant/adjuvant therapy in 182 hospitals. For neoadjuvant/ adjuvant patients, postoperative chemo-RT was administered in 4% of cases in 26 hospitals. No significant trends regarding treatment type were observed over time. Having undergone RT was inversely associated with being ! 60 years old and having a low income. Having undergone RT was positively related to having a Charlson comorbidity index ! 4, hospital location and hospital volume (! 2,000 beds). Significant portions of patients treated with RT in this nation (52%) were concentrated in one large-volume hospital. Use of RT linked to increased cost of primary treatment, yet not to reduced overall medical expense. RT did not influence both on overall and disease-specific survivals after adjusting for potential confounders (p > 0.05). Conclusion RT was uncommonly utilized as adjuvant or neoadjuvant treatment by physicians in Korea. Despite intrinsic drawback in this data, we did not find either survival benefit or net medical cost advantage by adding RT in adjuvant treatment.

참고문헌 (30)

  1. Torre LA, "Global cancer statistics, 2012", CA Cancer J Clin, 65, pp.87~108 (2015)[DOI]
  2. Colquhoun A, "Global patterns of cardia and non-cardia gastric cancer incidence in 2012", Gut, 64, pp.1881~1888 (2015)[DOI]
  3. 정규원, "Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2012", Cancer Research and Treatment, 47(2), pp.127~141 (2015), 대한암학회[DOI]
  4. Lim DH, "Patterns of failure in gastric carcinoma after D2 gastrectomy and chemoradiotherapy: a radiation oncologist's view", Br J Cancer, 91, pp.11~17 (2004)[DOI]
  5. Knight G, "Neoadjuvant or adjuvant therapy for resectable gastric cancer: a systematic review and practice guideline for North America", Gastric Cancer, 16, pp.28~40 (2013)[DOI]
  6. Fujitani K, "Overview of adjuvant and neoadjuvant therapy for resectable gastric cancer in the East", Dig Surg, 30, pp.119~129 (2013)[DOI]
  7. Macdonald JS, "Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction", N Engl J Med, 345, pp.725~730 (2001)[DOI]
  8. Lee J, "Phase III trial comparing capecitabine plus cisplatin versus capecitabine plus cisplatin with concurrent capecitabine radiotherapy in completely resected gastric cancer with D2 lymph node dissection: the ARTIST trial", J Clin Oncol, 30, pp.268~273 (2012)
  9. Verheij M, "A multicenter randomized phase III trial of neoadjuvant chemotherapy followed by surgery and chemotherapy or by surgery and chemoradiotherapy in resectable gastric cancer: first results from the CRITICS study", J Clin Oncol, 34(15 Suppl) (2016)
  10. Kim TH, "Phase 3 trial of postoperative chemotherapy alone versus chemoradiation therapy in stage III-IV gastric cancer treated with R0 gastrectomy and D2 lymph node dissection", Int J Radiat Oncol Biol Phys, 84, pp.e585~e592 (2012)[DOI]
  11. Sakuramoto S, "Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine", N Engl J Med, 357, pp.1810~1820 (2007)[DOI]
  12. Bang YJ, "Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial", Lancet, 379, pp.315~321 (2012)[DOI]
  13. Schmidt B, "D1 versus D2 lymphadenectomy for gastric cancer", J Surg Oncol, 107, pp.259~264 (2013)[DOI]
  14. Schwarz RE, "Clinical impact of lymphadenectomy extent in resectable gastric cancer of advanced stage", Ann Surg Oncol, 14, pp.317~328 (2007)[DOI]
  15. Lee J, "Cohort Profile: The National Health Insurance Service-National Sample Cohort (NHIS-NSC), South Korea", Int J Epidemiol, 46, pp.e15~ (2017)
  16. Charlson ME, "A new method of classifying prognostic comorbidity in longitudinal studies: development and validation", J Chronic Dis, 40, pp.373~383 (1987)[DOI]
  17. Choi KS, "Screening for gastric cancer in Korea: population-based preferences for endoscopy versus upper gastrointestinal series", Cancer Epidemiol Biomarkers Prev, 18, pp.1390~1398 (2009)[DOI]
  18. Smalley SR, "Updated analysis of SWOG-directed intergroup study 0116: a phase III trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection", J Clin Oncol, 30, pp.2327~2333 (2012)[DOI]
  19. Seyedin S, "Benefit of adjuvant chemoradiotherapy for gastric adenocarcinoma: a SEER population analysis", Gastrointest Cancer Res, 7, pp.82~90 (2014)
  20. Cheng J, "Radiotherapy patterns of care in gastric adenocarcinoma: a single institution experience", J Gastrointest Oncol, 6, pp.247~253 (2015)
  21. Ashraf N, "Adjuvant treatment for gastric cancer: chemotherapy versus radiation", Oncologist, 18, pp.1013~1021 (2013)[DOI]
  22. 대한위암학회 정보전산위원회, "2004년 전국 위암 등록사업 결과 보고", Journal of Gastric Cancer, 7(1), pp.47~54 (2007), 대한위암학회
  23. Cuschieri A, "Patient survival after D1 and D2 resections for gastric cancer: long-term results of the MRC randomized surgical trial. Surgical Co-operative Group", Br J Cancer, 79, pp.1522~1530 (1999)[DOI]
  24. Hartgrink HH, "Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial", J Clin Oncol, 22, pp.2069~2077 (2004)[DOI]
  25. Bonenkamp JJ, "Extended lymph-node dissection for gastric cancer", N Engl J Med, 340, pp.908~914 (1999)[DOI]
  26. Sano T, "Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy: Japan Clinical Oncology Group study 9501", J Clin Oncol, 22, pp.2767~2773 (2004)[DOI]
  27. Kim S, "An observational study suggesting clinical benefit for adjuvant postoperative chemoradiation in a population of over 500 cases after gastric resection with D2 nodal dissection for adenocarcinoma of the stomach", Int J Radiat Oncol Biol Phys, 63, pp.1279~1285 (2005)[DOI]
  28. Chang JS, "Postoperative adjuvant chemoradiotherapy in D2-dissected gastric cancer: is radiotherapy necessary after D2-dissection?", World J Gastroenterol, 20, pp.12900~12907 (2014)[DOI]
  29. Chang JS, "Patterns of regional recurrence after curative D2 resection for stage III (N3) gastric cancer: implications for postoperative radiotherapy", Radiother Oncol, 104, pp.367~373 (2012)[DOI]
  30. Yu JI, "Effects of adjuvant radiotherapy on completely resected gastric cancer: a radiation oncologist's view of the ARTIST randomized phase III trial", Radiother Oncol, 117, pp.171~177 (2015)[DOI]

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