The impact of implementing current treatment modalities and female sex on gastric cancer outcomes, 2000–2016: a longitudinal nationwide cohort study

Abstract

Background

The implementation of current treatment modalities and their impact on nationwide gastric cancer outcomes remain poorly understood. Biological differences between females and males could impact survival. We aimed to analyze rates of gastric surgery, chemotherapy, and radiotherapy as well as changes in overall survival among gastric cancer patients diagnosed between 2000–2008 and 2009–2016, respectively, in Finland.

Material and methods

Data on gastric cancer patients were collected from national registries. Cox regression analysis and the Kaplan–Meier method were used to analyze differences in survival.

Results

We identified 9223 histologically confirmed gastric cancer patients. The rate of gastric surgery decreased from 44% (n = 2282) to 34% (n = 1368; p < 0.001). The proportion of gastric surgery patients who underwent preoperative oncological treatment increased from 0.5% (n = 12) to 16.2% (n = 222) between the calendar periods (p < 0.001) and stood at 30% in 2016. The median overall survival (OS) improved from 30 months [95% confidence interval (CI) 28–33] to 38 months (95%CI 33–42; p = 0.006) and the period 2009–2016 independently associated with a lower risk of death [hazard ratio (HR) 0.78, 95%CI 0.70–0.87] among patients who underwent gastric surgery. Females exhibited a lower risk of death (HR 0.88, 95%CI 0.81–0.97) among patients who underwent gastric surgery.

Conclusion

Preoperative oncological treatment was gradually introduced into clinical practice and OS among gastric surgery patients improved. Moreover, female surgical patients exhibited a better survival than male patients.

Keywords:

• Gastric cancer
• epidemiology
• survival

Acknowledgments

We thank Vanessa Fuller, from Language Services at the University of Helsinki, for proofreading our manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Due to legal restrictions, the data underlying this study cannot be shared.

Additional information

Funding

This work was supported by the Finnish Cancer Society (HS and CH), the Helsinki University Hospital Research Fund (CH, PP, MS, and HS), the Sigrid Juselius Foundation (CH and HS), Finska Läkaresällskapet (MS), Medicinska Understödsföreningen Liv och Hälsa (MS), and the Georg C and Mary Ehrnrooths Foundation (HS). None of the funders participated in the study.