TY - JOUR
T1 - Patterns of relapse in patients with localized gastric adenocarcinoma who had surgery with or without adjunctive therapy
T2 - Costs and effectiveness of surveillance
AU - Elimova, Elena
AU - Slack, Rebecca S.
AU - Chen, Hsiang Chun
AU - Planjery, Venkatram
AU - Shiozaki, Hironori
AU - Shimodaira, Yusuke
AU - Charalampakis, Nick
AU - Lin, Quan
AU - Harada, Kazuto
AU - Wadhwa, Roopma
AU - Estrella, Jeannelyn S.
AU - Kaya, Dilsa Mizrak
AU - Sagebiel, Tara
AU - Lee, Jeffrey H.
AU - Weston, Brian
AU - Bhutani, Manoop
AU - Murphy, Mariela Blum
AU - Matamoros, Aurelio
AU - Minsky, Bruce
AU - Das, Prajnan
AU - Mansfield, Paul F.
AU - Badgwell, Brian D.
AU - Ajani, Jaffer A.
N1 - Funding Information:
The adjunctive therapies used for patients with localized GAC vary geographically. In North America and Europe, results from the INT-0116 [3] and British Medical Research Council Adjuvant Gastric Cancer Infusional Chemotherapy (MAGIC) trials have established
Funding Information:
Generous grants from the Caporella, Dallas, Sultan, Park, Smith, Frazier, Oaks, Vanstekelenberg, Planjery, and Cantu Families. From the Schecter Private Foundation, Rivercreek Foundation, Kevin Fund, Myer Fund, Dio Fund, Milrod Fund, and Multidisciplinary Grants from the University of Texas M. D. Anderson Cancer Center, Houston, USA. Supported in part by the National Cancer Institute and Department of Defense awards CA138671, CA172741, CA129926, CA150334 (JAA) and P30CA016672 to the Biostatistics Resource Group (RS, H-CC).
PY - 2017
Y1 - 2017
N2 - 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 localregional) 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.
AB - 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 localregional) 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.
KW - Cancer surveillance
KW - Cost-effectiveness analysis
KW - Esophagogastroduodenoscopy
KW - Imaging studies
KW - Localized gastric adenocarcinoma
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U2 - 10.18632/oncotarget.19226
DO - 10.18632/oncotarget.19226
M3 - Article
C2 - 29113402
AN - SCOPUS:85030629427
SN - 1949-2553
VL - 8
SP - 81430
EP - 81440
JO - Oncotarget
JF - Oncotarget
IS - 46
ER -