Li R, et al. - Researchers compared chemoradiation (CRT) to chemotherapy alone in terms of survival outcomes in patients with nonmetastatic gastric cancer. They found that CRT vs chemotherapy alone was related to improved survival in patients with stage I–III gastric cancer not undergoing surgical resection. However, CRT was used to treat only 30.8% of patients in this environment.

Methods

• Researchers used the National Cancer Database to identify patients with gastric adenocarcinoma from 2004 to 2015.
• They excluded patients if they had surgery, metastatic disease, or T0, Tis, or T1a disease.
• They used logistic regression to assess predictors of CRT use.
• Using Cox proportional hazards modeling, they compared overall survival (OS) between chemotherapy alone and CRT in overall and propensity score–matched cohorts.

Results

• At a median follow-up of 11.8 months, a total of 4,795 patients with stage I–III gastric adenocarcinoma who did not undergo surgery were identified.
• Chemotherapy alone was the mode of treatment in a total of 3,316 cases (69.2%) and CRT in 1,479 patients (30.8%).
• Identified predictors of increased CRT use included age ≥ 65 years (odds ratio [OR] 1.68; 95% CI, 1.43–1.99; P < .001), Charlson-Deyo comorbidity score ≥ 2 (OR, 1.46; 95% CI, 1.18–1.81), and treatment at a community facility (OR, 1.27; 95% CI, 1.07–1.51; P=.006).
• A 2-year OS rate of 28.3% vs 21.5% was reported among patients receiving CRT vs those receiving chemotherapy, respectively.
• In multivariate analysis, CRT was shown to be related to improved OS (hazard ratio [HR], 0.82; 95% CI, 0.77–0.89; P < .001).
• They noted a persistent survival benefit following propensity score matching (HR, 0.80; 95% CI, 0.74–0.88; P<.001).