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, 10 (4), 779-788
eCollection

Surgical Compliance and Outcomes in Gastric Cancer: A Population-Based Cohort Study

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Surgical Compliance and Outcomes in Gastric Cancer: A Population-Based Cohort Study

Guihua Liu et al. J Cancer.

Abstract

Background: Surgical resection is one of curative treatment for gastric cancer (GC), however, a set of patients show poor surgical compliance in the USA. We aimed to identify the risk factors associated with surgical compliance and investigate the difference in survival. Methods: GC patients diagnosed between 1973 and 2014 were identified from the Surveillance Epidemiology and End Results (SEER) databases. Based on different surgical compliance and treatment regimen, patients were classified into three subgroups: surgical compliance group, surgical noncompliance group, and non-surgical group. Multivariable Logistic regression analysis was adopted to identify the factors related to surgical compliance; Multivariable Cox regression was used to investigate the prognostic factors. Overall survival (OS) and cancer-specific survival (CSS) were analyzed using the Kaplan-Meier estimator method. Results: Of 79374 GC patients who were recommended for surgical therapy, 15201(19.2%) cases did not perform surgery. Poor compliance of surgery was related to old age, American Indian/Alaska Native race, poor grading/late staging, single/widowed status, lower socioeconomic status and earlier time of diagnosis. As expected, GC patients of surgical compliance group showed significantly more favorable survival than the other two groups (P<0.0001); notably, the outcome of surgical noncompliance group came close to that of non-surgical group. Conclusion: GC patients of poor surgical compliance demonstrated adverse survival, which was comparable to that of non-surgical patients. The poor surgical compliance was associated with older age, American Indian/Alaska Native race, poor tissue differentiation/advanced stage of tumor, single/widowed status, lower socioeconomic status and earlier time of diagnosis.

Keywords: Gastric cancer; Outcome; SEER; Surgical Compliance; Survival.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Stacked bars indicate the distribution of variables between surgical noncompliance group and non-surgical group. (A) the distribution of time of diagnosis which is divided into four chronological categories (Group A: 1973-1983, Group B: 1984-1993, Group C: 1994-2003, Group A: 2004-2014). (B) the distribution of age which is factitiously classified into four categories (<50y, 50-64y, 65-79y, ≥80y). (C) the distribution of pathological grading (Well differentiated, Grade I; Moderately differentiated, Grade II; Poorly differentiated, Grade III; Undifferentiated, anaplastic, Grade IV, Unknown). (D) the distribution of SEER tumor stage (Localized; Regional; Distant; Unknown)
Figure 2
Figure 2
Forest plot of Multivariable Logistic analyses of surgical noncompliance adjusted by the time of diagnosis, gender, age, race, ethnic origin, pathological grading, tumor stage, marital status, education level, economic income. The black squares on the transverse lines represent the hazard ratio (HR), and the transverse lines represent 95% CI. # Measure of educational level or economic income for each patient's area of residence is from 2012 American Community Survey data, and it is categorized into equally proportioned quartiles
Figure 3
Figure 3
Kaplan-Meier estimates of the Cancer-Specific survival (A) and Overall Survival (B) for the total cohort among three groups (surgical compliance group; surgical noncompliance group; non-surgical group)
Figure 4
Figure 4
Kaplan-Meier estimates of the Cancer-Specific survival (A) and Overall Survival (B) for the patients diagnosed in different period of time among three groups (surgical compliance group; surgical noncompliance group; non-surgical group)

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