Trends in the surgical treatment of gastric adenocarcinoma

In past decade, the treatment of gastric adenocarcinoma has evolved as a result of the publication of two seminal randomized controlled trials. We aimed to examine treatment trends for resectable gastric cancer (stage I-III) using the National Cancer Data Base (NCDB). Our hypothesis was that the use of chemotherapy and chemoradiotherapy in addition to surgery for the treatment of gastric adenocarcinoma has increased from 2000 to 2009.

Patients diagnosed with stage I-III gastric adenocarcinoma between 2000 and 2009 were selected from the NCDB Hospital Comparison Benchmark Reports. Attention was paid to the initial treatment regimen and data on hospital setting were collected and analyzed. The Cochran-Armitage test for trend was used to assess changes in treatment over time.

A total of 50,778 patients with stage I-III gastric adenocarcinoma were included in the analysis. Between 2000 and 2009, the use of surgery alone decreased significantly across all three stages at both teaching hospitals and community hospitals (p < 0.0001 for all cases). In the same period, the use of chemotherapy in addition to surgery increased significantly across all three stages and at both hospital settings (p < 0.0001 for all cases). Surgery plus chemoradiotherapy increased for stage I-III disease at community hospitals (p < 0.05 for all) but only increased significantly for stage II disease at teaching hospitals (p < 0.01). Incidentally, nonsurgical treatment increased across all three stages at both hospital settings (p < 0.001 for all cases).

Data from the NCDB from 2000 to 2009 demonstrate that there has been an increasing use of chemotherapy in addition to surgery for resectable gastric cancer.