Estimating survival scenarios in advanced or metastatic gastric and oesophageal adenocarcinoma: a systematic review of randomized-controlled trials

Abstract

Background

We aimed to summarize survival data from RCTs in patients with GO adenocarcinoma; estimate and explain worst-, typical-, and best-case-scenarios of survival time; and determine if simple multiples of median overall survival (mOS) could estimate these percentiles.

Methods

We systematically searched RCTs of systemic therapies for GO adenocarcinoma published 2000–2022. The following key percentiles were extracted from overall survival curves: 90th (worst-case), 75th (lower-typical), 25th (upper-typical), and 10th (best-case). We tested if these percentiles could be estimated by simple multiples of mOS: 0.25 of the median for the 90^th percentile, 0.5 for the 75^th, 2 for the 25^th, and 3 for the 10^th.

Results

We identified 44 trials (22,447 participants). For first line chemotherapy and immunotherapy combined (CI) trials (n = 3) worst-to-best case survival time ranged from 4 months to not reached, compared to 3–30 months for other trials (n = 27) and 1–23 months for subsequent lines (n = 14). Simple multiples of mOS accurately estimated the following survival percentiles: 90^th (n = 3/3 trials), 75^th (n = 3/3), and 25^th (n = 2/3) in first line CI trials. In other first line trials, the mOS accurately estimated the 90^th survival percentile in n = 22/27 trials, 75^th percentile in n = 26/27, 25^th percentile in 27/27 trials, and 10^th percentile in 22/27 trials. Simple multiples of the mOS accurately predicted the 90^th, 75^th, 25^th, and 10^th survival percentiles in the majority of trials of second and subsequent lines apart from chemotherapy and immunotherapy only trials.

Conclusion

We provide realistic, evidence-based prognostic information as scenarios for survival time which can inform clinical decision-making. Simple multiples of the mOS accurately estimated the percentiles for most groups.

Keywords:

• Prognosis
• gastric adenocarcinoma
• advanced
• metastatic
• communication

Transparency

Declaration of funding

This study is a part of Sayeda K. Naher’s PhD project, for which she is supported by a NHMRC CTC University of Sydney post graduate research scholarship. Rebecca Mercieca-Bebber is supported by a NHMRC CTC Early Career Fellowship (APP1138100).

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Sayeda K. Naher, Derrick Siu. The first draft of the manuscript was written by Sayeda K. Naher and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Acknowledgements

Authors acknowledge the assistance from two University of Sydney Librarians – Tess Aitken and Jessica Hughes for developing search terms.

Data availability statement

The datasets generated during and/or analyzed during the current study are available from the CONTACT on reasonable request.

Previous presentation

Medical Oncology Group of Australia (MOGA) Annual Scientific Meeting (ASM) August 2023 – oral and poster presentation. NSW Cancer Conference September 2023 – poster presentation.