Secular trends in the use, quality, and outcomes of gastrectomy for noncardia gastric cancer in the United States

Quy Hoa Le Thi, David Berger, Melvin Lau, Hashem B. El-Serag

Research output: Contribution to journalArticle

Abstract

Background: The overall survival with non-cardia gastric adenocarcinoma in the United States has remained poor and relatively unchanged over the past 2 decades. This brings into question the utilization and quality of gastrectomy and lymphadenectomy. We examined the trends, extent, and determinants of surgical treatment and the influence of gastrectomy and adequacy of lymphadenectomy (defined as collection of 15 or more lymph nodes) on non-cardia gastric cancer survival. Methods: Data from Surveillance, Epidemiology, and End Results (SEER) registries was used to identify patients with non-cardia adenocarcinoma diagnosed during 1983-2002. Logistic regression was used to examine determinants of gastric resection and adequacy of lymphadenectomy. Cox proportional hazard (PH) models were used to examine determinants of mortality risk for patients treated surgically. All models examined year of diagnosis, age, race, gender, geographic region, and cancer spread. Results: There were 16,846 patients with non-cardia gastric cancer of whom 10,534 (62.5%) underwent gastric resection. Approximately 77.9% with localized disease underwent resection. Resection for non-cardia gastric cancer declined 6% for all stages and 20% for local stages between 1983 and 2002. In multivariable models, gastrectomies were less likely to be performed between 1998-2002 (-37% compared to 1983-1987), for localized disease (-78% compared to regional disease), for patients older than 70 (-39% compared to patients younger than 40), and for patients from New Mexico (-45% compared to highest in Hawaii). Wide racial variability was also found (lowest for Whites [-54%] compared to Asians). Adequate LN sampling (15 or more LN) was recorded in only 25% overall and 20% of localized disease. Improvement in LN collection since 1997 has been modest, with only a 7% relative increase. The mortality risk of surgically treated non-cardia cancer patients has been unchanged for 15 years. Adequate lymphadenectomy was associated with a 19% decreased mortality risk in this group. Gender and racial differences in mortality risk were present (up to 13% higher in men compared to women and 22% higher in Whites compared Asians). Conclusion: Gastrectomy for non-cardia gastric adenocarcinoma is underutilized, especially for localized disease. In the majority of operations for non-cardia gastric cancer, LN collection is inadequate. Racial and geographic variations with gastric resection and LN sampling are as significant as patient age and stage of the cancer. Disparities based on race and geographic region, as well as surgeon and facility factors need to be investigated and addressed to bring forth improvements in outcomes for non-cardia adenocarcinoma.

Original languageEnglish (US)
Pages (from-to)2519-2527
Number of pages9
JournalAnnals of Surgical Oncology
Volume14
Issue number9
DOIs
StatePublished - Sep 2007
Externally publishedYes

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Gastrectomy
Stomach Neoplasms
Stomach
Lymph Node Excision
Adenocarcinoma
Mortality
Neoplasms
Survival
Proportional Hazards Models
Registries
Epidemiology
Logistic Models
Lymph Nodes

Keywords

  • Epidermiology
  • Gastroctomy
  • Lymph node
  • Outcomes
  • SEER
  • Variations

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Secular trends in the use, quality, and outcomes of gastrectomy for noncardia gastric cancer in the United States. / Le Thi, Quy Hoa; Berger, David; Lau, Melvin; El-Serag, Hashem B.

In: Annals of Surgical Oncology, Vol. 14, No. 9, 09.2007, p. 2519-2527.

Research output: Contribution to journalArticle

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title = "Secular trends in the use, quality, and outcomes of gastrectomy for noncardia gastric cancer in the United States",
abstract = "Background: The overall survival with non-cardia gastric adenocarcinoma in the United States has remained poor and relatively unchanged over the past 2 decades. This brings into question the utilization and quality of gastrectomy and lymphadenectomy. We examined the trends, extent, and determinants of surgical treatment and the influence of gastrectomy and adequacy of lymphadenectomy (defined as collection of 15 or more lymph nodes) on non-cardia gastric cancer survival. Methods: Data from Surveillance, Epidemiology, and End Results (SEER) registries was used to identify patients with non-cardia adenocarcinoma diagnosed during 1983-2002. Logistic regression was used to examine determinants of gastric resection and adequacy of lymphadenectomy. Cox proportional hazard (PH) models were used to examine determinants of mortality risk for patients treated surgically. All models examined year of diagnosis, age, race, gender, geographic region, and cancer spread. Results: There were 16,846 patients with non-cardia gastric cancer of whom 10,534 (62.5{\%}) underwent gastric resection. Approximately 77.9{\%} with localized disease underwent resection. Resection for non-cardia gastric cancer declined 6{\%} for all stages and 20{\%} for local stages between 1983 and 2002. In multivariable models, gastrectomies were less likely to be performed between 1998-2002 (-37{\%} compared to 1983-1987), for localized disease (-78{\%} compared to regional disease), for patients older than 70 (-39{\%} compared to patients younger than 40), and for patients from New Mexico (-45{\%} compared to highest in Hawaii). Wide racial variability was also found (lowest for Whites [-54{\%}] compared to Asians). Adequate LN sampling (15 or more LN) was recorded in only 25{\%} overall and 20{\%} of localized disease. Improvement in LN collection since 1997 has been modest, with only a 7{\%} relative increase. The mortality risk of surgically treated non-cardia cancer patients has been unchanged for 15 years. Adequate lymphadenectomy was associated with a 19{\%} decreased mortality risk in this group. Gender and racial differences in mortality risk were present (up to 13{\%} higher in men compared to women and 22{\%} higher in Whites compared Asians). Conclusion: Gastrectomy for non-cardia gastric adenocarcinoma is underutilized, especially for localized disease. In the majority of operations for non-cardia gastric cancer, LN collection is inadequate. Racial and geographic variations with gastric resection and LN sampling are as significant as patient age and stage of the cancer. Disparities based on race and geographic region, as well as surgeon and facility factors need to be investigated and addressed to bring forth improvements in outcomes for non-cardia adenocarcinoma.",
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T1 - Secular trends in the use, quality, and outcomes of gastrectomy for noncardia gastric cancer in the United States

AU - Le Thi, Quy Hoa

AU - Berger, David

AU - Lau, Melvin

AU - El-Serag, Hashem B.

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N2 - Background: The overall survival with non-cardia gastric adenocarcinoma in the United States has remained poor and relatively unchanged over the past 2 decades. This brings into question the utilization and quality of gastrectomy and lymphadenectomy. We examined the trends, extent, and determinants of surgical treatment and the influence of gastrectomy and adequacy of lymphadenectomy (defined as collection of 15 or more lymph nodes) on non-cardia gastric cancer survival. Methods: Data from Surveillance, Epidemiology, and End Results (SEER) registries was used to identify patients with non-cardia adenocarcinoma diagnosed during 1983-2002. Logistic regression was used to examine determinants of gastric resection and adequacy of lymphadenectomy. Cox proportional hazard (PH) models were used to examine determinants of mortality risk for patients treated surgically. All models examined year of diagnosis, age, race, gender, geographic region, and cancer spread. Results: There were 16,846 patients with non-cardia gastric cancer of whom 10,534 (62.5%) underwent gastric resection. Approximately 77.9% with localized disease underwent resection. Resection for non-cardia gastric cancer declined 6% for all stages and 20% for local stages between 1983 and 2002. In multivariable models, gastrectomies were less likely to be performed between 1998-2002 (-37% compared to 1983-1987), for localized disease (-78% compared to regional disease), for patients older than 70 (-39% compared to patients younger than 40), and for patients from New Mexico (-45% compared to highest in Hawaii). Wide racial variability was also found (lowest for Whites [-54%] compared to Asians). Adequate LN sampling (15 or more LN) was recorded in only 25% overall and 20% of localized disease. Improvement in LN collection since 1997 has been modest, with only a 7% relative increase. The mortality risk of surgically treated non-cardia cancer patients has been unchanged for 15 years. Adequate lymphadenectomy was associated with a 19% decreased mortality risk in this group. Gender and racial differences in mortality risk were present (up to 13% higher in men compared to women and 22% higher in Whites compared Asians). Conclusion: Gastrectomy for non-cardia gastric adenocarcinoma is underutilized, especially for localized disease. In the majority of operations for non-cardia gastric cancer, LN collection is inadequate. Racial and geographic variations with gastric resection and LN sampling are as significant as patient age and stage of the cancer. Disparities based on race and geographic region, as well as surgeon and facility factors need to be investigated and addressed to bring forth improvements in outcomes for non-cardia adenocarcinoma.

AB - Background: The overall survival with non-cardia gastric adenocarcinoma in the United States has remained poor and relatively unchanged over the past 2 decades. This brings into question the utilization and quality of gastrectomy and lymphadenectomy. We examined the trends, extent, and determinants of surgical treatment and the influence of gastrectomy and adequacy of lymphadenectomy (defined as collection of 15 or more lymph nodes) on non-cardia gastric cancer survival. Methods: Data from Surveillance, Epidemiology, and End Results (SEER) registries was used to identify patients with non-cardia adenocarcinoma diagnosed during 1983-2002. Logistic regression was used to examine determinants of gastric resection and adequacy of lymphadenectomy. Cox proportional hazard (PH) models were used to examine determinants of mortality risk for patients treated surgically. All models examined year of diagnosis, age, race, gender, geographic region, and cancer spread. Results: There were 16,846 patients with non-cardia gastric cancer of whom 10,534 (62.5%) underwent gastric resection. Approximately 77.9% with localized disease underwent resection. Resection for non-cardia gastric cancer declined 6% for all stages and 20% for local stages between 1983 and 2002. In multivariable models, gastrectomies were less likely to be performed between 1998-2002 (-37% compared to 1983-1987), for localized disease (-78% compared to regional disease), for patients older than 70 (-39% compared to patients younger than 40), and for patients from New Mexico (-45% compared to highest in Hawaii). Wide racial variability was also found (lowest for Whites [-54%] compared to Asians). Adequate LN sampling (15 or more LN) was recorded in only 25% overall and 20% of localized disease. Improvement in LN collection since 1997 has been modest, with only a 7% relative increase. The mortality risk of surgically treated non-cardia cancer patients has been unchanged for 15 years. Adequate lymphadenectomy was associated with a 19% decreased mortality risk in this group. Gender and racial differences in mortality risk were present (up to 13% higher in men compared to women and 22% higher in Whites compared Asians). Conclusion: Gastrectomy for non-cardia gastric adenocarcinoma is underutilized, especially for localized disease. In the majority of operations for non-cardia gastric cancer, LN collection is inadequate. Racial and geographic variations with gastric resection and LN sampling are as significant as patient age and stage of the cancer. Disparities based on race and geographic region, as well as surgeon and facility factors need to be investigated and addressed to bring forth improvements in outcomes for non-cardia adenocarcinoma.

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KW - Gastroctomy

KW - Lymph node

KW - Outcomes

KW - SEER

KW - Variations

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