METHODS: This multicenter registry designed and propensity score analysis study described the diagnosis characteristics, treatment-pattern development and survival status of AGC from 10 hospitals in China between January 1, 2000 and July 31, 2021. Overall survival (OS) was evaluated between non-CM cohort (standard medical treatment) and CM cohort (integrated standard CM treatment ≥3 months). Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were performed to adjust any difference in average outcomes for bias.
RESULTS: A total of 2,001 patients histologically confirmed locally advanced and/or metastasis stomach and gastroesophageal junction adenocarcinoma were enrolled. Among them, 1,607 received systemic chemotherapy, 215 (10.74%) accepted molecular targeted therapy, 44 (2.2%) received checkpoint inhibitor therapy, and 769 (38.43%) received CM. Two-drug regimen was the main choice for first-line treatment, with fluoropyrimidine plus platinum as the most common regimen (530 cases, 60.09%). While 45.71% (16 cases) of patients with HER2 amplification received trastuzumab in first-line. The application of apatinib increased (33.33%) in third-line. The application of checkpoint inhibitors has increased since 2020. COX analysis showed that Lauren mixed type (P=0.017), cycles of first-line treatment >6 (P=0.000), CM (P=0.000), palliative gastrectomy (P=0.000), trastuzumab (P=0.011), and apatinib (P=0.008) were independent prognostic factors for the OS of AGC. After PSM and IPTW, the median OS of CM cohort and non-CM cohort was 18.17 and 12.45 months, respectively (P<0.001).
CONCLUSIONS: In real-world practice for AGC in China, therapy choices consisted with guidelines. Two-drug regimen was the main first-line choice. Standardized CM treatment was an independent prognostic factor and could prolong the OS of Chinese patients with AGC. (Registration No. NCT02781285).
方法:这项多中心注册设计和倾向评分分析研究描述了诊断特征,2000年1月1日至2021年7月31日,中国10家医院的AGC治疗模式发展和生存状况。评估非CM队列(标准药物治疗)和CM队列(综合标准CM治疗≥3个月)之间的总生存期(OS)。进行倾向评分匹配(PSM)和治疗加权逆概率(IPTW),以调整平均结果中的任何偏差差异。
结果:共纳入2,001例经组织学证实为局部晚期和/或转移的胃和胃食管交界处腺癌。其中,1,607人接受全身化疗,215(10.74%)接受分子靶向治疗,44(2.2%)接受了检查点抑制剂治疗,769(38.43%)收到CM。两药方案是一线治疗的主要选择,以氟嘧啶加铂为最常见的方案(530例,60.09%)。而45.71%(16例)的HER2扩增患者一线接受曲妥珠单抗治疗。三线阿帕替尼的应用增加(33.33%)。自2020年以来,检查点抑制剂的应用有所增加。COX分析显示,Lauren混合型(P=0.017),一线治疗周期>6(P=0.000),CM(P=0.000),姑息性胃切除术(P=0.000),曲妥珠单抗(P=0.011),和阿帕替尼(P=0.008)是AGCOS的独立预后因素。在PSM和IPTW之后,CM队列和非CM队列的中位OS分别为18.17和12.45个月,分别(P<0.001)。
结论:在中国AGC的实际实践中,治疗选择与指南相关.两药方案是主要的一线选择。规范化CM治疗是中国AGC患者的独立预后因素,可以延长OS。(登记号NCT02781285)。