1. Attrition during neoadjuvant chemotherapy for gastric adenocarcinoma is associated with decreased survival: A United States Safety‐Net Collaborative analysis
- Author
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Kronenfeld, Joshua P, Collier, Amber L, Turgeon, Michael K, Ju, Michelle, Alterio, Rodrigo, Wang, Annie, Fernandez, Manuel, Porembka, Matthew R, Richter, Harry, Lee, Ann Y, Russell, Maria C, Merchant, Nipun B, Maker, Ajay V, and Datta, Jashodeep
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Oncology and Carcinogenesis ,Clinical Research ,Patient Safety ,Cancer ,Digestive Diseases ,Evaluation of treatments and therapeutic interventions ,6.4 Surgery ,Activities of Daily Living ,Adenocarcinoma ,Adolescent ,Adult ,Aged ,Aged ,80 and over ,Antineoplastic Combined Chemotherapy Protocols ,Female ,Follow-Up Studies ,Humans ,Male ,Middle Aged ,Neoadjuvant Therapy ,Prognosis ,Retrospective Studies ,Stomach Neoplasms ,Survival Rate ,Young Adult ,completion of therapy ,gastric cancer ,neoadjuvant therapy ,Oncology & Carcinogenesis ,Oncology and carcinogenesis - Abstract
BackgroundNeoadjuvant chemotherapy (NAC) is standard management for localized gastric cancer (GC). Attrition during NAC due to treatment-related toxicity or functional decline is considered a surrogate for worse biologic outcomes; however, data supporting this paradigm are lacking. We investigated factors predicting attrition and its association with overall survival (OS) in GC.MethodsPatients with nonmetastatic GC initiating NAC were identified from the US Safety-Net Collaborative (2012-2014). Patient/treatment-related characteristics were compared between attrition/nonattrition cohorts. Cox models determined factors associated with OS.ResultsOf 116 patients initiating NAC, attrition during prescribed NAC occurred in 24%. No differences were observed in performance status, comorbidities, treatment at safety-net hospital, or clinicopathologic factors between cohorts. Despite absence of distinguishing factors, attrition was associated with worse OS (median: 11 vs. 37 months; p = 0.01) and was an independent predictor of mortality (hazard ratio [HR]: 4.7, 95% confidence interval [CI]: 1.5-15.2; p = 0.02). Fewer patients with attrition underwent curative-intent surgery (39% vs. 89%; p
- Published
- 2021