Chemotherapy Treatment Patterns and Survival Outcomes among Gastric Cancer Patients

• Main Authors: Wan-Hsuan Hung, 洪婉瑄
• Other Authors: Yi-Hsin Yang
• Format: Others
• Language: en_US
• Published: 2016
• Online Access: http://ndltd.ncl.edu.tw/handle/41393518637102951167

碩士 === 高雄醫學大學 === 藥學系臨床藥學碩士班 === 104 === Background Gastric cancer (GC) is the fifth most common malignancy and the third leading cause of cancer death worldwide. In Taiwan, gastric cancer is the fifth most common malignancy and the seventh most common cause of cancer-related deaths in 2012. Due to the reimbursement policy for gastric cancer chemotherapy in Taiwan, the chemotherapy usage patterns may be different from other countries. Therefore, our study aim is to investigate the chemotherapy treatment patterns in GC patients and to compare the survival outcomes of chemotherapy regimens for their effectiveness on mortality reduction of each regimen. Methods We conducted a retrospective population-based cohort study by analyzing the Taiwan Health Insurance Research Database (NHIRD). We included newly-diagnosed gastric cancer patients aged 18 years old or older during 2003‐2011. Patients who received chemotherapy were divided into postoperative chemotherapy and chemotherapy alone. We further computed overall survival (OS) rates of chemotherapy regimens by using Kaplan-Meier estimates. The Cox regressions were used to estimate the hazard ratios (HRs) and 95% confidence intervals after adjusting for covariates including gender, age, income, time to treatment and comorbidities. Result Totally, 11,007 patients are identified with newly diagnosed gastric cancer in this study. Among them, there are 1,562 postoperative patients receiving regimens which are reimbursed for adjuvant chemotherapy, 4,333 postoperative patients receiving regimens which are reimbursed for palliative chemotherapy, and 4.290 patients receiving chemotherapy alone. Fluoropyrimidine-base single agent (F) and fluoropyrimidine-base plus platinum-base (FP) regimen are the most common regimens in postoperative adjuvant chemotherapy and in postoperative palliative chemotherapy group and chemotherapy alone group. In postoperative adjuvant chemotherapy group, fluoropyrimidine-base plus etoposide (EtoF) regimen has better survival outcome. The 1-year, 2-year and 3-year OS are 85.5%, 70.6% and 67.6% respectively. In postoperative palliative chemotherapy group, fluoropyrimidine-base plus polysaccharide-k (PSK) regimen (FK) has better survival outcomes (median survival time: 6.3 years) than other regimens. For patients in chemotherapy alone group, fluoropyrimidine-base single agent has the best long-term survival than other regimens with 3-year OS of 14.8%, but the difference was not statistically significant. Conclusion In Taiwan, fluoropyrimidine-base single agent (F) and fluoropyrimidine-base plus platinum-base (FP) regimen are the most common chemotherapy regimens for GC patients. In postoperative adjuvant chemotherapy group, fluoropyrimidine-base plus etoposide (EtoF) regimen has better survival outcome. Besides, in postoperative palliative chemotherapy group, fluoropyrimidine-base plus polysaccharide-k (PSK) regimen (FK) has better survival outcome than other regimens.