Trends in best‐case, typical and worst‐case survival scenarios of patients with non‐metastatic esophagogastric cancer between 2006 and 2020: A population‐based study

Abstract

New treatment options and centralization of surgery have improved survival for patients with non-metastatic esophageal or gastric cancer. It is unknown, however, which patients benefitted the most from treatment advances. The aim of this study was to identify best-case, typical and worst-case scenarios in terms of survival time, and to assess if survival associated with these scenarios changed over time. Patients with non-metastatic potentially resectable esophageal or gastric cancer diagnosed between 2006 and 2020 were selected from the Netherlands Cancer Registry. Best-case (20th percentile), upper-typical (40th percentile), typical (median), lower-typical (60th percentile) and worst-case (80th percentile) survival scenarios were defined, and regression analysis was used to investigate the change in survival time for each scenario across years. For patients with esophageal cancer (N = 24 352) survival time improved on average 12.0 (until 2011), 1.5 (until 2018), 0.7, 0.4 and 0.2 months per year for the best-case, upper-typical, median, lower-typical and worst-case scenario, respectively. For patients with gastric cancer (N = 9993) survival time of the best-case scenario remained constant, whereas the upper-typical, median, lower-typical and worst-case scenario improved on average with 1.0 (until 2018), 0.5, 0.2 and 0.2 months per year, respectively. Subgroup analyses showed that, survival scenarios improved for nearly all patients across treatment groups and for patients with squamous cell carcinomas or adenocarcinomas. Survival improved for almost all patients suggesting that in clinical practice the vast majority of patients benefitted from treatment advances.

Implementation of Best Practices in Pancreatic Cancer Care in the Netherlands

“…Since such a study design has not been used before in patients with pancreatic cancer, it was difficult to predict to what extent the use of systemic chemotherapy and other best practices could be improved. Importantly, for other cancers with poor survival, such as esophageal and gastric cancer, it has also been shown that improvements in survival are mainly observed in selected best-case patients, while improvement of survival for the population as a whole is not observed . Moreover, the Netherlands is a small country, even though significant variability in practice is present, this is potentially less variable compared with other (larger) countries.…”

Perioperative Chemotherapy for Gastro-Esophageal or Gastric Cancer: Anthracyclin Triplets versus FLOT

“…Treatment and survival of patients with gastric or gastro-esophageal junctional (GEJ) carcinoma have shown progress over the last decades. The introduction of perioperative chemotherapy for resectable disease and centralization of gastric surgery have improved patients' prognosis as shown in clinical trials [1,2]. Despite these improvements, 5-year survival rate for potentially curable gastric cancer patients in the Netherlands has only seen a minor increase from 27% during 2000-2010 to 34% in 2011-2020 [3].…”