Changes in treatment patterns and their influence on long-term survival in patients with stages I-III gastric cancer in The Netherlands

Studies investigating perioperative chemotherapy and/or radiotherapy changed the treatment of curable gastric cancer in The Netherlands. These changes were evaluated including their influence on survival. Data on patients diagnosed with gastric cancer from 1989 to 2009 were obtained from The Netherlands Cancer Registry. Changes over time in surgery and administration of perioperative chemotherapy, 30-day mortality, 5-year survival and adjusted relative excess risk (RER) of dying were analyzed with multivariable regression for cardia and noncardia cancer. In stages I and II disease, most patients underwent surgery. Since 2005, more patients are treated with (neo)adjuvant chemotherapy. Postoperative mortality ranged from 1% to 7% and 0.4% to 12.2% in cardia and noncardia cancer (<55 to 75+ years). Five-year survival for cardia cancer and noncardia cancer stages I-III and X (unknown stage) was 33% and 50% (2005-2008). The RER of dying was associated with period of diagnosis, age, gender, region, stage, (neo)adjuvant chemotherapy in case of cardia cancer and type of gastric resection in case of noncardia cancer. Administration of (neo)adjuvant chemotherapy has increased. No improvement in long-term survival could yet be seen, though it is still too early to expect an improvement in survival as a result of the use of chemotherapy. What's new? Studies in the early 2000s in the Netherlands revealed that radiation therapy and chemotherapy given after or at the time of surgery could reduce the chances of gastric cancer recurrence. These findings led to significant changes nationwide in guidelines for gastric cancer treatment, the impacts of which were evaluated here, based on Netherlands Cancer Registry data. The data show exponential growth in administration of perioperative chemotherapy and a decline in postoperative mortality rate. By 2008, however, still more than half of patients were treated with surgery alone, suggesting that additional benefits may yet be derived.