Abstract：
BACKGROUND: Although receipt of neoadjuvant chemotherapy has been identified to improve unfavorable survival outcomes among patients with locally advanced gastric cancer (LAGC), several randomized controlled trials have not demonstrated a difference in oncological outcomes/overall survival (OS) among patients undergoing minimally invasive surgery (MIS) versus open gastrectomy. This study aimed to investigate National Comprehensive Cancer Network (NCCN) guideline adherence and textbook oncological outcome (TOO) among patients undergoing MIS versus open surgery for LAGC.
METHODS: In this cross-sectional study, patients with stage II/III LAGC (cT2-T4N0-3M0) who underwent curative-intent treatment between 2013 and 2019 were evaluated using the National Cancer Database. Multivariable analysis was performed to assess the association between surgical approach, NCCN guideline adherence, TOO, and OS. The study was registered on the International Standard Randomised Controlled Trial Number registry (registration number: ISRCTN53410429) and conducted according to the Strengthening The Reporting Of Cohort Studies in Surgery and Strengthening the Reporting of Observational Studies in Epidemiology guidelines.
RESULTS: Among 13,885 patients, median age at diagnosis was 68 years (IQR, 59-76); most patients were male (n = 9887, 71.2%) and identified as White (n = 10,295, 74.1%). Patients who underwent MIS (n = 4692, 33.8%) had improved NCCN guideline adherence and TOO compared with patients who underwent open surgery (51.3% vs 43.5% and 36.7% vs 27.3%, respectively; both P < .001). Adherence to NCCN guidelines and likelihood to achieve TOO increased from 2013 to 2019 (35.6% vs 50.9% and 31.4% vs 46.4%, respectively; both P < .001). Moreover, improved median OS was observed among patients with NCCN guideline adherence and TOO undergoing MIS versus open surgery (57.3 vs 49.8 months [P = .041] and 68.4 vs 60.6 months [P = .025], respectively).
CONCLUSIONS: An overall increase in guideline-adherent treatment and achievement of TOO among patients with LAGC undergoing multimodal and curative-intent treatment in the United States was observed. Adoption of minimally invasive gastrectomy may result in improved short- and long-term outcomes.
METHODS: In this cross-sectional study, patients with stage II/III LAGC (cT2-T4N0-3M0) who underwent curative-intent treatment between 2013 and 2019 were evaluated using the National Cancer Database. Multivariable analysis was performed to assess the association between surgical approach, NCCN guideline adherence, TOO, and OS. The study was registered on the International Standard Randomised Controlled Trial Number registry (registration number: ISRCTN53410429) and conducted according to the Strengthening The Reporting Of Cohort Studies in Surgery and Strengthening the Reporting of Observational Studies in Epidemiology guidelines.
RESULTS: Among 13,885 patients, median age at diagnosis was 68 years (IQR, 59-76); most patients were male (n = 9887, 71.2%) and identified as White (n = 10,295, 74.1%). Patients who underwent MIS (n = 4692, 33.8%) had improved NCCN guideline adherence and TOO compared with patients who underwent open surgery (51.3% vs 43.5% and 36.7% vs 27.3%, respectively; both P < .001). Adherence to NCCN guidelines and likelihood to achieve TOO increased from 2013 to 2019 (35.6% vs 50.9% and 31.4% vs 46.4%, respectively; both P < .001). Moreover, improved median OS was observed among patients with NCCN guideline adherence and TOO undergoing MIS versus open surgery (57.3 vs 49.8 months [P = .041] and 68.4 vs 60.6 months [P = .025], respectively).
CONCLUSIONS: An overall increase in guideline-adherent treatment and achievement of TOO among patients with LAGC undergoing multimodal and curative-intent treatment in the United States was observed. Adoption of minimally invasive gastrectomy may result in improved short- and long-term outcomes.
摘要：
背景：尽管已确定接受新辅助化疗可改善局部晚期胃癌（LAGC）患者的不良生存结局，几项随机对照试验未显示接受微创手术(MIS)和开腹胃切除术的患者在肿瘤结局/总生存期(OS)方面存在差异.这项研究旨在调查接受MIS与LAGC开放手术的患者的国家综合癌症网络（NCCN）指南依从性和教科书肿瘤学结果（TOO）。
方法：在这项横断面研究中，我们使用国家癌症数据库评估了2013年至2019年期间接受根治性治疗的II/III期LAGC(cT2-T4N0-3M0)患者.进行了多变量分析以评估手术入路，NCCN指南遵守情况，TOO,和OS。该研究已在国际标准随机对照试验编号注册表（注册号：ISRCTN53410429）上注册，并根据《加强外科队列研究报告和加强流行病学观察研究报告指南》进行。
结果：在13,885名患者中，诊断时的中位年龄为68岁(IQR，59-76）；大多数患者为男性（n=9887，71.2％），鉴定为白人（n=10,295，74.1％）。与接受开放手术的患者相比，接受MIS（n=4692，33.8％）的NCCN指南依从性和TOO有所提高（51.3％vs43.5％和36.7％vs27.3％，分别；两者P<.001)。从2013年到2019年，遵守NCCN指南和实现TOO的可能性增加(35.6%对50.9%和31.4%对46.4%，分别；两者P<.001)。此外，在接受MIS手术的NCCN指南依从性和TOO患者中，观察到中位OS改善（57.3vs49.8个月[P=.041]和68.4vs60.6个月[P=.025]，分别)。
结论：在美国接受多模式和治愈性治疗的LAGC患者中，指南依从性治疗和TOO成就的总体增加。采用微创胃切除术可能会改善短期和长期预后。
方法：在这项横断面研究中，我们使用国家癌症数据库评估了2013年至2019年期间接受根治性治疗的II/III期LAGC(cT2-T4N0-3M0)患者.进行了多变量分析以评估手术入路，NCCN指南遵守情况，TOO,和OS。该研究已在国际标准随机对照试验编号注册表（注册号：ISRCTN53410429）上注册，并根据《加强外科队列研究报告和加强流行病学观察研究报告指南》进行。
结果：在13,885名患者中，诊断时的中位年龄为68岁(IQR，59-76）；大多数患者为男性（n=9887，71.2％），鉴定为白人（n=10,295，74.1％）。与接受开放手术的患者相比，接受MIS（n=4692，33.8％）的NCCN指南依从性和TOO有所提高（51.3％vs43.5％和36.7％vs27.3％，分别；两者P<.001)。从2013年到2019年，遵守NCCN指南和实现TOO的可能性增加(35.6%对50.9%和31.4%对46.4%，分别；两者P<.001)。此外，在接受MIS手术的NCCN指南依从性和TOO患者中，观察到中位OS改善（57.3vs49.8个月[P=.041]和68.4vs60.6个月[P=.025]，分别)。
结论：在美国接受多模式和治愈性治疗的LAGC患者中，指南依从性治疗和TOO成就的总体增加。采用微创胃切除术可能会改善短期和长期预后。
