Patterns of Care for Patients With Locally Advanced Rectal Cancer Treated with Total Neoadjuvant Therapy at Predominately Academic Centers between 2016-2020: An NCDB Analysis

IF 3.3 3区 医学 Q2 ONCOLOGY
Jason Liu , Colton Ladbury , Scott Glaser , Marwan Fakih , Andreas M. Kaiser , Yi-Jen Chen , Terence M. Williams , Arya Amini
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引用次数: 2

Abstract

Total neoadjuvant therapy (TNT) has emerged as the preferred approach for locally advanced rectal cancer (LARC), defined as T3/4 or any T with N+ disease. Our objective was to (1) determine the proportion of patients with LARC receiving TNT over time, (2) determine the most common method in which TNT is being delivered, and (3) determine what factors are associated with a greater likelihood of receiving TNT in the United States. Retrospective data was obtained from the National Cancer Database (NCDB) for patients diagnosed with rectal cancer between 2016 and 2020. Patients were excluded if they had M1 disease, T1-2 N0 disease, incomplete staging information, nonadenocarcinoma histology, received RT to a nonrectum site, or received a nondefinitive RT dose. Data were analyzed using linear regression, χ2 test, and binary logistic regression. Of the 26,375 patients included, most patients were treated at an academic facility (94.6%). Five thousand three (19.0%) patients received TNT, and 21,372 (81.0%) patients did not receive TNT. The proportion of patients receiving TNT increased significantly over time, from 6.1% in 2016 to 34.6% in 2020 (slope = 7.36, 95% CI 4.58-10.15, R2 = 0.96, P = .040). The most common TNT regimen was multiagent chemotherapy followed by long-course chemoradiation (73.2% of cases from 2016-2020). There was a significant increase in utilization of short-course RT as part of TNT from 2.8% in 2016 to 13.7% in 2020 (slope = 2.74, 95% CI 0.37-5.11, R2 = 0.82, P = .035). Factors associated with a lower likelihood of TNT usage included age >65, female gender, Black race, and T3 N0 disease. TNT use in the United States has increased significantly from 2016-2020, with approximately 34.6% of patients with LARC receiving TNT in 2020. The observed trend appears to be in line with the recent National Comprehensive Cancer Network guidelines recommending TNT as the preferred approach.

2016-2020年期间,在主要学术中心接受全新辅助治疗的局部晚期癌症患者的护理模式:NCDB分析
全新辅助治疗(TNT)已成为局部晚期癌症(LARC)的首选方法,定义为T3/4或任何T伴N+疾病。我们的目标是(1)确定LARC患者接受TNT治疗的比例,(2)确定TNT最常见的输送方法,以及(3)确定哪些因素与美国接受TNT的可能性更大有关。从国家癌症数据库(NCDB)获得2016年至2020年间诊断为癌症患者的回顾性数据。如果患者患有M1疾病、T1-2 N0疾病、分期信息不完整、非腺癌组织学、接受了不可复发部位的RT或接受了不确定的RT剂量,则将其排除在外。数据采用线性回归、χ2检验和二元逻辑回归进行分析。在26375名患者中,大多数患者在学术机构接受治疗(94.6%)。五十三名(19.0%)患者接受了TNT治疗,21372名(81.0%)患者没有接受TNT治疗。随着时间的推移,接受TNT治疗的患者比例显著增加,从2016年的6.1%增加到2020年的34.6%(斜率=7.36,95%CI 4.58-10.15,R2=0.96,P=0.040)。最常见的TNT方案是多药剂化疗,然后是长期放化疗(2016-2020年73.2%的病例)。短期RT作为TNT的一部分的利用率从2016年的2.8%显著增加到2020年的13.7%(斜率=2.74,95%CI 0.37-5.11,R2=0.82,P=.035);65岁,女性,黑人,T3 N0疾病。自2016-2020年以来,美国TNT的使用量显著增加,2020年约有34.6%的LARC患者接受TNT治疗。观察到的趋势似乎与最近的国家综合癌症网络指南一致,该指南建议TNT作为首选方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Clinical colorectal cancer
Clinical colorectal cancer 医学-肿瘤学
CiteScore
5.50
自引率
2.90%
发文量
64
审稿时长
27 days
期刊介绍: Clinical Colorectal Cancer is a peer-reviewed, quarterly journal that publishes original articles describing various aspects of clinical and translational research of gastrointestinal cancers. Clinical Colorectal Cancer is devoted to articles on detection, diagnosis, prevention, and treatment of colorectal, pancreatic, liver, and other gastrointestinal cancers. The main emphasis is on recent scientific developments in all areas related to gastrointestinal cancers. Specific areas of interest include clinical research and mechanistic approaches; drug sensitivity and resistance; gene and antisense therapy; pathology, markers, and prognostic indicators; chemoprevention strategies; multimodality therapy; and integration of various approaches.
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