title: No improvement in median survival for patients with metastatic gastric cancer despite increased use of chemotherapy.
abstract: BACKGROUND
  Gastric cancer often presents in a metastasized stage. We conducted a population-based study to evaluate trends in systemic treatment and survival of metastatic noncardia gastric cancer.
  
  
  METHODS
  All patients with noncardia adenocarcinoma of the stomach, diagnosed between 1990 and 2011 in the Eindhoven Cancer Registry area in the Netherlands were included (N = 4797). We conducted multivariable logistic regression analysis to evaluate trends in administration of palliative chemotherapy and multivariable proportional hazards regression analyses to evaluate trends in crude overall survival.
  
  
  RESULTS
  The proportion of patients presenting with metastatic gastric cancer increased from 24% in 1990 to 44% in 2011 (P < 0.0001). The use of palliative chemotherapy increased, from 5% in 1990 to 36% in 2011, with a strong increase in particular after 2006 (P < 0.0001). Younger patients [<50 years: adjusted odds ratio (ORadj) 3.9, P < 0.001; 50-59 years: ORadj 1.7, P = 0.01] and patients with a high socioeconomic status (ORadj 1.7, P = 0.01) more often received chemotherapy. In contrast, older patients (70-79 years: ORadj 0.3, P < 0.001; 80+ years: ORadj 0.02, P < 0.001), patients with comorbidity (ORadj 0.6, P = 0.03), linitis plastica (ORadj 0.5, P = 0.03) and multiple distant metastases (ORadj 0.5, P = 0.01) were less often treated with chemotherapy. A large hospital variation was observed in the administration of palliative chemotherapy (9%-27%). Median overall survival remained constant between 15 [95% confidence interval (CI) 11.9-17.7] and 17 (95% CI 15.0-20.0) weeks (P = 0.10).
  
  
  CONCLUSIONS
  The increased administration of chemotherapy in patients with metastatic gastric cancer did not lead to an increase in population-based overall survival. Identification of the subgroup of patients which benefits from palliative chemotherapy is of utmost importance to avoid unnecessary treatment.
authors.affiliation: Eindhoven Cancer Registry, Comprehensive Cancer Centre South, Eindhoven.
authors.forename: N
authors.initials: N
authors.lastname: Bernards
authors.forename: G J
authors.initials: GJ
authors.lastname: Creemers
authors.forename: G A P
authors.initials: GA
authors.lastname: Nieuwenhuijzen
authors.forename: K
authors.initials: K
authors.lastname: Bosscha
authors.forename: J F M
authors.initials: JF
authors.lastname: Pruijt
authors.forename: V E P P
authors.initials: VE
authors.lastname: Lemmens
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000556:secondary; D016015:Logistic Models; D008175:Lung Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D013274:Stomach Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000473:pathology; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: chemotherapy; gastric cancer; hospital variation; metastasis; survival