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• W2532384452 abstract "Introduction: Tumor biology is considered the predominant force that drives outcomes. This applies to the management of gastric carcinoma, as aggressive histologies lead to poor outcomes, despite surgery. This study assesses the impact of gastric cancer histologies on survival in a large US sample of patients with resectable gastric cancer. Methods: The 2003-2012 ACS National Cancer Database was analyzed for patients with stages 0-III gastric cancer who underwent definitive surgical resection. Treatment groups were first stratified according to commonly presenting histology: intestinal type, diffuse type, signet ring cell (SRC), mucinous, and mixed cell type. Univariate and multivariable survival analyses were performed. Histology cohorts were then combined according to aggressiveness, forming two distinct cohorts: intestinal/mucinous and diffuse/SRC. Propensity score matching was performed to determine rates of mortality after matching on demographic, surgery-related, and tumor-related variables. Results: Of 8,367 patients with resectable gastric cancer, histologies included 27.8% (N = 2,328) intestinal type, 10.9% (N = 916) diffuse type, 7.8% (N = 654) mucinous, 47.9% (N = 4,008) SRC, and 5.6% (N = 461) mixed cell type. In univariate analysis, patients with diffuse type and SRC tumors more often were younger with less comorbidity but more frequently underwent total gastrectomy and had positive surgical margins (p < 0.0001, all), relative to all other histologies. Diffuse type tumors more frequently were lymph node positive (p < 0.0001). Patients with intestinal type and mucinous tumors more frequently were older and with more comorbidities but had negative surgical margins and no lymph node involvement (p < 0.0001, all). After controlling for demographics, chemotherapy, surgery, and tumor-related variables, only patients with diffuse type adenocarcinoma had increased hazards of overall mortality relative to intestinal type histology (HR = 1.13, p = 0.047). After analyses revealed a pattern of more aggressive behavior among diffuse type and SRC tumors relative to intestinal type and mucinous tumors, propensity score matching was undertaken between these two groups. No difference in mortality rates was found between matched cohorts in stage I cancer, but worse mortality was found in stages II and III in the diffuse/SRC cohort, after matching on all other prognostic variables (Stage II: diffuse/SRC, 50.50% vs. intestinal/mucinous, 40.06%, p < 0.0001; stage III: 65.70% vs. 52.43%, p < 0.0001, respectively). Conclusion: Regardless of other prognostic factors and therapeutic intervention, gastric tumors with diffuse type and SRC histologies yield worse patient survival relative to intestinal type and mucinous tumors. Further investigation is warranted to determine whether a different or more aggressive treatment strategy should be employed for these patients." @default.
• W2532384452 created "2016-10-28" @default.
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• W2532384452 date "2016-06-01" @default.
• W2532384452 modified "2023-09-29" @default.
• W2532384452 title "O-006 Survival impact of histology for resectable gastric cancer: a multicenter US observation study" @default.
• W2532384452 doi "https://doi.org/10.1093/annonc/mdw198.06" @default.
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