荷兰可切除胃癌患者接受氟尿嘧啶、亮菌素、奥沙利铂和多西他赛围术期化疗的情况

IF 7.6 1区医学 Q1 ONCOLOGY

European Journal of Cancer Pub Date : 2024-11-20 DOI:10.1016/j.ejca.2024.115137

Julie F.M. Geerts , Marieke Pape , Pauline A.J. Vissers , Rob H.A. Verhoeven , Bianca Mostert , Bas P.L. Wijnhoven , Camiel Rosman , Irene E.G. van Hellemond , Grard A.P. Nieuwenhuijzen , Hanneke W.M. van Laarhoven

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引用次数: 0

摘要

背景FLOT4试验表明，与蒽环类三联疗法相比，5-氟尿嘧啶、奥沙利铂和多西他赛（FLOT）围手术期化疗治疗可切除胃癌的生存率更高。这些结果于2017年6月在美国临床肿瘤学会（ASCO）大会上公布，并于2019年4月发表。然而，在临床实践中采用新疗法往往会遇到延误。本研究评估了荷兰临床实践中围手术期化疗使用和FLOT吸收的模式。材料和方法对2015-2020年间来自荷兰癌症登记处的可切除胃癌患者（cT1-4a,XcNallcM0）进行了回顾性队列研究。研究采用了描述性统计、Cochran-Armitage 检验、Fisher's 精确检验或非配对 T 检验以及 Jonckheere-Terpstra 检验来分析各医院的化疗趋势和 FLOT 采用率。结果在 3290 名纳入研究的患者中，42.9% 接受了新辅助治疗。2015年，43.6%的患者接受了围手术期化疗，而2020年为43.5%（P = 0.63）。62 家医院中有 40 家（64.5%）在 ASCO 演讲和全文发表之间采用了 FLOT。FLOT的使用率从发表前的42.9%上升到发表后的86.8%（p = 0.0001），而蒽环类三联疗法的使用率下降到0.9%（p = 0.0001）。医院规模越大，采用FLOT的天数越少（p = 0.04），但在FLOT公布前采用FLOT的天数则越少（p = 0.14）。制定（国家间）关于在试验结果公布前调整临时治疗方案的指导原则对于减少治疗机会的差异至关重要。此外，快速公布最终试验结果对于减少实践中的差异和确保患者得到公平治疗也至关重要。

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Patient access to perioperative chemotherapy with fluorouracil, leucovorin, oxaliplatin and docetaxel in patients with resectable gastric cancer in the Netherlands

Background

The FLOT4 trial demonstrated superior survival of perioperative chemotherapy with 5-fluorouracil, oxaliplatin, and docetaxel (FLOT) compared to anthracycline triplets for resectable gastric cancer. These results were presented at the American Society of Clinical Oncology (ASCO) congress in June 2017 and published in April 2019. However, adoption of novel treatments in clinical practice often encounters delays. This study assesses the patterns of perioperative chemotherapy utilization and FLOT uptake in clinical practice within the Netherlands.

Materials and methods

A retrospective cohort study was conducted with resectable gastric cancer patients (cT_1–4a,XcN_allcM₀) between 2015–2020 from the Netherlands Cancer Registry. Descriptive statistics, Cochran-Armitage tests, Fisher's exact or unpaired T-tests, and Jonckheere-Terpstra tests were used to analyze chemotherapy trends and FLOT uptake across hospitals.

Results

Among 3290 included patients, 42.9 % received neoadjuvant treatment. In 2015, 43.6 % of patients received perioperative chemotherapy versus 43.5 % in 2020 (p = 0.63). 40 out of 62 hospitals (64.5 %) adopted FLOT between the ASCO presentation and the full publication. FLOT increased from 42.9 % before publication to 86.8 % after publication (p < 0.0001), while anthracycline triplet use decreased to 0.9 % (p < 0.0001). Higher hospital volume was associated with fewer days to adoption (p = 0.04) but not with adoption of FLOT before publication (p = 0.14).

Conclusion

Timing of FLOT adoption varied among Dutch hospitals, leading to unequal patient access to effective treatments. Establishing (inter)national guidelines on provisional treatment adjustment pending publication is crucial to reduce variation in access. Moreover, rapid publication of final trial results is imperative to reduce variation in practice and ensure fair patient treatment.

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来源期刊

European Journal of Cancer 医学-肿瘤学

CiteScore

11.50

自引率

4.80%

发文量

953

审稿时长

23 days

期刊介绍： The European Journal of Cancer (EJC) serves as a comprehensive platform integrating preclinical, digital, translational, and clinical research across the spectrum of cancer. From epidemiology, carcinogenesis, and biology to groundbreaking innovations in cancer treatment and patient care, the journal covers a wide array of topics. We publish original research, reviews, previews, editorial comments, and correspondence, fostering dialogue and advancement in the fight against cancer. Join us in our mission to drive progress and improve outcomes in cancer research and patient care.