Abstract
PurposeThe survival of esophageal and gastric cancer patients treated with chemotherapy is rarely assessed outside of clinical trials. Therefore, we compared the effectiveness of various curative or palliative chemotherapy regimens on the survival of esophageal and gastric cancer patients in a “real world” clinical setting.MethodsWe identified a cohort of 966 incident esophageal and gastric cancer patients in Stockholm/Gotland County (a low-risk Western population) during 2008–2013. Patients who received chemotherapy with curative intention (n = 279) and palliative intention (n = 182) were analyzed separately. Using Cox proportional hazards regression models, we estimated hazard ratios (HRs) with 95% confidence intervals (CIs) and adjusted for the potential confounding factors: age, sex, TNM stage, radiotherapy, comorbidity, marital status, education, income, and country of birth.ResultsIn esophageal cancer patients with curative treatment intention, we observed a higher hazard for death among patients who received carboplatin-fluorouracil compared to patients who received cisplatin-fluorouracil, corresponding to a HR of 2.18 (95% CI 1.09–4.37). Conversely, in patients with cancer in the gastroesophageal junction who had a curative treatment intention at diagnosis, we observed a reduced hazard for death among those who received fluorouracil-oxaliplatin, compared to patients who received cisplatin-fluorouracil (HR 0.28; 95% CI 0.08–0.96).ConclusionAmong patients with esophageal cancer who received treatment with curative intention, cisplatin-fluorouracil was associated with better survival compared to carboplatin-fluorouracil, while patients with gastroesophageal junction cancer who were treated with cisplatin-fluorouracil had worse survival compared to fluorouracil-oxaliplatin.
Highlights
Patients with esophageal and gastric cancer (EC and GC) have a very poor prognosis with an overall mortality to incidence ratio of 0.89 and 0.76, respectively, according to an IARC (International Agency for Research on Cancer) report [1]
In addition to radical tumor resection, neoadjuvant chemoradiotherapy or chemotherapy for EC patients and perioperative chemotherapy or adjuvant chemotherapy for GC patients have been established in clinical practice as an add-on treatment alternative to prolong survival [5], except for a minority of patients with cervical EC who can be cured with chemoradiotherapy alone [6]
Our results show that patients with curative treatment intention were younger than those with palliative treatment intention
Summary
Patients with esophageal and gastric cancer (EC and GC) have a very poor prognosis with an overall mortality to incidence ratio of 0.89 and 0.76, respectively, according to an IARC (International Agency for Research on Cancer) report [1]. The poor prognosis is mainly due to delayed diagnosis caused by late presentation of symptoms, when the disease usually has reached an advanced, metastatic stage. At this stage, the gold standard treatment, curative surgery, is no longer beneficial for the majority of patients [2]. The majority of patients are excluded from these clinical trials due to their advanced disease, poor physical conditions, and/or co-morbidities [15]. Follow-up data on post-marketing chemotherapy effectiveness and patient survival in the clinical, “real-world” setting are limited. Such information is of interest for regulators, caregivers, and patients. Previous post-marketing studies on EC and GC from the “real-world” setting are few and their results are inconclusive [17,18,19,20,21]
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