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Adherence with operative standards in the treatment of gastric cancer in the United States
Background Despite multiple clinical trials and practice guidelines for the treatment of gastric cancer, oncologic outcomes have not improved in the United States. One potential reason could be differences in the quality of surgery as performed in a controlled trial versus in practice. Methods Using...
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| Published in: | Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 2020-05, Vol.23 (3), p.550-560 |
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| container_end_page | 560 |
| container_issue | 3 |
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| container_title | Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association |
| container_volume | 23 |
| creator | Zhao, Beiqun Blair, Sarah L. Katz, Matthew H. G. Lowy, Andrew M. Kelly, Kaitlyn J. |
| description | Background
Despite multiple clinical trials and practice guidelines for the treatment of gastric cancer, oncologic outcomes have not improved in the United States. One potential reason could be differences in the quality of surgery as performed in a controlled trial versus in practice.
Methods
Using the National Cancer Database, rates of adherence with operative standards for gastrectomy for cancer were analyzed. Of the numerous evidence-based operative standards outlined in the manual, two were reliably measured in the NCDB: (1) achieving and R0 resection, and (2) having > 16 lymph nodes examined. Univariable and multivariable Cox proportional hazard modeling and logistic regression were performed.
Results
A total of 28,705 patients with gastric adenocarcinoma who underwent curative-intent gastrectomy during 2004–2014 were identified. Only 36.5% of stage 0/I patients, and 41.8% of stage II/III patients, met minimum standards. Predictors for meeting standards included age |
| doi_str_mv | 10.1007/s10120-019-01028-5 |
| format | article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2316435422</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2391222753</sourcerecordid><originalsourceid>FETCH-LOGICAL-c443t-2d20077d7aec3041588361aa4350a463b3fd03e095efbfb0f6d7440241c10aca3</originalsourceid><addsrcrecordid>eNp9kMtKAzEUhoMoXqov4EICbtyMnpPLTGcp4g0EF9qNm5AmZ-xIO1OTVPHtjbZVcOEiJJDv_0_yMXaIcIoA1VlEQAEFYJ0XiGGhN9guKlkWUoLeXJ9FjTtsL8YXANQ1lttsR2KldFnVu-zp3E8oUOeIv7dpwvs5BZvaN-Ix2c7b4CNvO54mxFMgm2bUJd43_NnGFFrHnc3RsEZGXZvI84dkE8V9ttXYaaSD1T5go6vLx4ub4u7--vbi_K5wSslUCC_yZypfWXISFOrhUJZorZIarCrlWDYeJEGtqRk3Y2hKXykFQqFDsM7KATtZ9s5D_7qgmMysjY6mU9tRv4hGSCxzmRIio8d_0Jd-Ebr8ukzVKISotMyUWFIu9DEGasw8tDMbPgyC-TJvluZNNm--zRudQ0er6sV4Rv4nsladAbkEYr7qnin8zv6n9hO8V40j</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2391222753</pqid></control><display><type>article</type><title>Adherence with operative standards in the treatment of gastric cancer in the United States</title><source>Springer Link</source><creator>Zhao, Beiqun ; Blair, Sarah L. ; Katz, Matthew H. G. ; Lowy, Andrew M. ; Kelly, Kaitlyn J.</creator><creatorcontrib>Zhao, Beiqun ; Blair, Sarah L. ; Katz, Matthew H. G. ; Lowy, Andrew M. ; Kelly, Kaitlyn J.</creatorcontrib><description>Background
Despite multiple clinical trials and practice guidelines for the treatment of gastric cancer, oncologic outcomes have not improved in the United States. One potential reason could be differences in the quality of surgery as performed in a controlled trial versus in practice.
Methods
Using the National Cancer Database, rates of adherence with operative standards for gastrectomy for cancer were analyzed. Of the numerous evidence-based operative standards outlined in the manual, two were reliably measured in the NCDB: (1) achieving and R0 resection, and (2) having > 16 lymph nodes examined. Univariable and multivariable Cox proportional hazard modeling and logistic regression were performed.
Results
A total of 28,705 patients with gastric adenocarcinoma who underwent curative-intent gastrectomy during 2004–2014 were identified. Only 36.5% of stage 0/I patients, and 41.8% of stage II/III patients, met minimum standards. Predictors for meeting standards included age < 65, fewer comorbidities, Asian/Pacific Islander race, and treatment at academic and high-volume centers. Patients who met standards had longer OS (stage 0/I: 104.9 versus 66.6 months; stage II/III: 40.6 versus 26.0 months;
p
< 0.001 for both). Meeting standards was a significant predictor for improved OS for both stage 0/I and II/III patients (HR = 0.665 and HR = 0.747, respectively,
p
< 0.001 for both).
Conclusions
For standards that are measurable in the NCDB, adherence is poor. Improved adherence with operative standards may improve survival for gastric cancer patients in the U.S. There is a need for better measuring of, and adherence with, operative standards in gastrectomy for cancer.</description><identifier>ISSN: 1436-3291</identifier><identifier>EISSN: 1436-3305</identifier><identifier>DOI: 10.1007/s10120-019-01028-5</identifier><identifier>PMID: 31745679</identifier><language>eng</language><publisher>Singapore: Springer Singapore</publisher><subject>Abdominal Surgery ; Adenocarcinoma ; Adenocarcinoma - pathology ; Adenocarcinoma - surgery ; Adult ; Aged ; Aged, 80 and over ; Cancer Research ; Clinical trials ; Female ; Follow-Up Studies ; Gastrectomy ; Gastrectomy - mortality ; Gastric cancer ; Gastroenterology ; Guideline Adherence ; Humans ; Lymph Node Excision - mortality ; Lymph nodes ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Oncology ; Original Article ; Patients ; Practice Guidelines as Topic - standards ; Practice Patterns, Physicians' - standards ; Prognosis ; Retrospective Studies ; Stomach Neoplasms - pathology ; Stomach Neoplasms - surgery ; Surgery ; Surgical Oncology ; Survival Rate ; Young Adult</subject><ispartof>Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 2020-05, Vol.23 (3), p.550-560</ispartof><rights>The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2019</rights><rights>The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2019.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c443t-2d20077d7aec3041588361aa4350a463b3fd03e095efbfb0f6d7440241c10aca3</citedby><cites>FETCH-LOGICAL-c443t-2d20077d7aec3041588361aa4350a463b3fd03e095efbfb0f6d7440241c10aca3</cites><orcidid>0000-0003-2181-3783</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31745679$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Zhao, Beiqun</creatorcontrib><creatorcontrib>Blair, Sarah L.</creatorcontrib><creatorcontrib>Katz, Matthew H. G.</creatorcontrib><creatorcontrib>Lowy, Andrew M.</creatorcontrib><creatorcontrib>Kelly, Kaitlyn J.</creatorcontrib><title>Adherence with operative standards in the treatment of gastric cancer in the United States</title><title>Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association</title><addtitle>Gastric Cancer</addtitle><addtitle>Gastric Cancer</addtitle><description>Background
Despite multiple clinical trials and practice guidelines for the treatment of gastric cancer, oncologic outcomes have not improved in the United States. One potential reason could be differences in the quality of surgery as performed in a controlled trial versus in practice.
Methods
Using the National Cancer Database, rates of adherence with operative standards for gastrectomy for cancer were analyzed. Of the numerous evidence-based operative standards outlined in the manual, two were reliably measured in the NCDB: (1) achieving and R0 resection, and (2) having > 16 lymph nodes examined. Univariable and multivariable Cox proportional hazard modeling and logistic regression were performed.
Results
A total of 28,705 patients with gastric adenocarcinoma who underwent curative-intent gastrectomy during 2004–2014 were identified. Only 36.5% of stage 0/I patients, and 41.8% of stage II/III patients, met minimum standards. Predictors for meeting standards included age < 65, fewer comorbidities, Asian/Pacific Islander race, and treatment at academic and high-volume centers. Patients who met standards had longer OS (stage 0/I: 104.9 versus 66.6 months; stage II/III: 40.6 versus 26.0 months;
p
< 0.001 for both). Meeting standards was a significant predictor for improved OS for both stage 0/I and II/III patients (HR = 0.665 and HR = 0.747, respectively,
p
< 0.001 for both).
Conclusions
For standards that are measurable in the NCDB, adherence is poor. Improved adherence with operative standards may improve survival for gastric cancer patients in the U.S. There is a need for better measuring of, and adherence with, operative standards in gastrectomy for cancer.</description><subject>Abdominal Surgery</subject><subject>Adenocarcinoma</subject><subject>Adenocarcinoma - pathology</subject><subject>Adenocarcinoma - surgery</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Cancer Research</subject><subject>Clinical trials</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastrectomy</subject><subject>Gastrectomy - mortality</subject><subject>Gastric cancer</subject><subject>Gastroenterology</subject><subject>Guideline Adherence</subject><subject>Humans</subject><subject>Lymph Node Excision - mortality</subject><subject>Lymph nodes</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Oncology</subject><subject>Original Article</subject><subject>Patients</subject><subject>Practice Guidelines as Topic - standards</subject><subject>Practice Patterns, Physicians' - standards</subject><subject>Prognosis</subject><subject>Retrospective Studies</subject><subject>Stomach Neoplasms - pathology</subject><subject>Stomach Neoplasms - surgery</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Survival Rate</subject><subject>Young Adult</subject><issn>1436-3291</issn><issn>1436-3305</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp9kMtKAzEUhoMoXqov4EICbtyMnpPLTGcp4g0EF9qNm5AmZ-xIO1OTVPHtjbZVcOEiJJDv_0_yMXaIcIoA1VlEQAEFYJ0XiGGhN9guKlkWUoLeXJ9FjTtsL8YXANQ1lttsR2KldFnVu-zp3E8oUOeIv7dpwvs5BZvaN-Ix2c7b4CNvO54mxFMgm2bUJd43_NnGFFrHnc3RsEZGXZvI84dkE8V9ttXYaaSD1T5go6vLx4ub4u7--vbi_K5wSslUCC_yZypfWXISFOrhUJZorZIarCrlWDYeJEGtqRk3Y2hKXykFQqFDsM7KATtZ9s5D_7qgmMysjY6mU9tRv4hGSCxzmRIio8d_0Jd-Ebr8ukzVKISotMyUWFIu9DEGasw8tDMbPgyC-TJvluZNNm--zRudQ0er6sV4Rv4nsladAbkEYr7qnin8zv6n9hO8V40j</recordid><startdate>20200501</startdate><enddate>20200501</enddate><creator>Zhao, Beiqun</creator><creator>Blair, Sarah L.</creator><creator>Katz, Matthew H. G.</creator><creator>Lowy, Andrew M.</creator><creator>Kelly, Kaitlyn J.</creator><general>Springer Singapore</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2181-3783</orcidid></search><sort><creationdate>20200501</creationdate><title>Adherence with operative standards in the treatment of gastric cancer in the United States</title><author>Zhao, Beiqun ; Blair, Sarah L. ; Katz, Matthew H. G. ; Lowy, Andrew M. ; Kelly, Kaitlyn J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c443t-2d20077d7aec3041588361aa4350a463b3fd03e095efbfb0f6d7440241c10aca3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Abdominal Surgery</topic><topic>Adenocarcinoma</topic><topic>Adenocarcinoma - pathology</topic><topic>Adenocarcinoma - surgery</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Cancer Research</topic><topic>Clinical trials</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gastrectomy</topic><topic>Gastrectomy - mortality</topic><topic>Gastric cancer</topic><topic>Gastroenterology</topic><topic>Guideline Adherence</topic><topic>Humans</topic><topic>Lymph Node Excision - mortality</topic><topic>Lymph nodes</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Oncology</topic><topic>Original Article</topic><topic>Patients</topic><topic>Practice Guidelines as Topic - standards</topic><topic>Practice Patterns, Physicians' - standards</topic><topic>Prognosis</topic><topic>Retrospective Studies</topic><topic>Stomach Neoplasms - pathology</topic><topic>Stomach Neoplasms - surgery</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Survival Rate</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Zhao, Beiqun</creatorcontrib><creatorcontrib>Blair, Sarah L.</creatorcontrib><creatorcontrib>Katz, Matthew H. G.</creatorcontrib><creatorcontrib>Lowy, Andrew M.</creatorcontrib><creatorcontrib>Kelly, Kaitlyn J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Zhao, Beiqun</au><au>Blair, Sarah L.</au><au>Katz, Matthew H. G.</au><au>Lowy, Andrew M.</au><au>Kelly, Kaitlyn J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Adherence with operative standards in the treatment of gastric cancer in the United States</atitle><jtitle>Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association</jtitle><stitle>Gastric Cancer</stitle><addtitle>Gastric Cancer</addtitle><date>2020-05-01</date><risdate>2020</risdate><volume>23</volume><issue>3</issue><spage>550</spage><epage>560</epage><pages>550-560</pages><issn>1436-3291</issn><eissn>1436-3305</eissn><notes>ObjectType-Article-1</notes><notes>SourceType-Scholarly Journals-1</notes><notes>ObjectType-Feature-2</notes><notes>content type line 23</notes><abstract>Background
Despite multiple clinical trials and practice guidelines for the treatment of gastric cancer, oncologic outcomes have not improved in the United States. One potential reason could be differences in the quality of surgery as performed in a controlled trial versus in practice.
Methods
Using the National Cancer Database, rates of adherence with operative standards for gastrectomy for cancer were analyzed. Of the numerous evidence-based operative standards outlined in the manual, two were reliably measured in the NCDB: (1) achieving and R0 resection, and (2) having > 16 lymph nodes examined. Univariable and multivariable Cox proportional hazard modeling and logistic regression were performed.
Results
A total of 28,705 patients with gastric adenocarcinoma who underwent curative-intent gastrectomy during 2004–2014 were identified. Only 36.5% of stage 0/I patients, and 41.8% of stage II/III patients, met minimum standards. Predictors for meeting standards included age < 65, fewer comorbidities, Asian/Pacific Islander race, and treatment at academic and high-volume centers. Patients who met standards had longer OS (stage 0/I: 104.9 versus 66.6 months; stage II/III: 40.6 versus 26.0 months;
p
< 0.001 for both). Meeting standards was a significant predictor for improved OS for both stage 0/I and II/III patients (HR = 0.665 and HR = 0.747, respectively,
p
< 0.001 for both).
Conclusions
For standards that are measurable in the NCDB, adherence is poor. Improved adherence with operative standards may improve survival for gastric cancer patients in the U.S. There is a need for better measuring of, and adherence with, operative standards in gastrectomy for cancer.</abstract><cop>Singapore</cop><pub>Springer Singapore</pub><pmid>31745679</pmid><doi>10.1007/s10120-019-01028-5</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0003-2181-3783</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Abdominal Surgery Adenocarcinoma Adenocarcinoma - pathology Adenocarcinoma - surgery Adult Aged Aged, 80 and over Cancer Research Clinical trials Female Follow-Up Studies Gastrectomy Gastrectomy - mortality Gastric cancer Gastroenterology Guideline Adherence Humans Lymph Node Excision - mortality Lymph nodes Male Medicine Medicine & Public Health Middle Aged Oncology Original Article Patients Practice Guidelines as Topic - standards Practice Patterns, Physicians' - standards Prognosis Retrospective Studies Stomach Neoplasms - pathology Stomach Neoplasms - surgery Surgery Surgical Oncology Survival Rate Young Adult |
| title | Adherence with operative standards in the treatment of gastric cancer in the United States |
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