Patterns of relapse in patients with localized gastric adenocarcinoma who had surgery with or without adjunctive therapy: costs and effectiveness of surveillance.

Autor:	Elimova E; Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.; Department of Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada., Slack RS; Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA., Chen HC; Department of Biostatistics, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA., Planjery V; Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA., Shiozaki H; Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA., Shimodaira Y; Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA., Charalampakis N; Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA., Lin Q; Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA., Harada K; Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA., Wadhwa R; Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA., Estrella JS; Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA., Kaya DM; Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA., Sagebiel T; Department of Diagnostic Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA., Lee JH; Department of Gastroenterology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA., Weston B; Department of Gastroenterology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA., Bhutani M; Department of Gastroenterology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA., Murphy MB; Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA., Matamoros A; Department of Diagnostic Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA., Minsky B; Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA., Das P; Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA., Mansfield PF; Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA., Badgwell BD; Department of Surgical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA., Ajani JA; Department of Gastrointestinal Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
Jazyk:	angličtina
Zdroj:	Oncotarget [Oncotarget] 2017 Jul 13; Vol. 8 (46), pp. 81430-81440. Date of Electronic Publication: 2017 Jul 13 (Print Publication: 2017).
DOI:	10.18632/oncotarget.19226
Abstrakt:	Purpose: After therapy of localized gastric adenocarcinoma (GAC) patients, the costs of surveillance, relapse patterns, and possibility of salvage are unknown. Materials and Methods: We identified 246 patients, who after having a negative peritoneal staging, received therapy (any therapy which included surgery) and were surveyed (every 3-6 months in the first 3 years, then yearly; ∼10 CTs and ∼7 endoscopies per patient). We used the 2016 Medicare dollars reimbursed as the "costs" for surveillance. Results: Common features were: Caucasians (57%), men (60%), poorly differentiated histology (76%), preoperative chemotherapy (74%), preoperative chemoradiation (59%), and had surgery (100%). At a median follow-up of 3.7 years (range, 0.1 to 18.3), the median overall survival (OS) was 9.2 years (95% CI, 6.0 to 11.2). Tumor grade ( p = 0.02), p/yp stage ( p < 0.001), % residual GAC ( p = 0.05), the R status ( p = 0.01), total gastrectomy ( p = 0.001), and relapse type ( p = 0.02) were associated with OS. Relapse occurred in 79 (32%) patients (only 8% were local-regional) and 90% occurred within 36 months of surgery. P/yp stage ( p < 0.001) and total gastrectomy ( p = 0.01) were independent prognosticators for OS in the multivariate analysis. Only 1 relapsed patient had successful salvage therapy. The estimated reimbursement for imaging studies and endoscopies was $1,761,221.91 (marked underestimation of actual costs). Conclusions: The median OS of localized GAC patients was excellent with infrequent local-regional relapses. Rigorous surveillance had a low yield and high "costs". Our data suggest that less frequent surveillance intervals and limiting expensive investigations to symptomatic patients may be warranted. Competing Interests: CONFLICTS OF INTEREST All authors have declared no conflicts of interest.
Databáze:	MEDLINE
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