Variations in Stage at Diagnosis, Surgical Treatment, and Survival among Patients of Metropolitan Residence: An Analysis of Gastric Adenocarcinoma Patients Using the National Cancer Data Base, 2004-2012. Open Access

Raycraft, Meghan (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/m326m2257?locale=en
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Abstract

Background: Gastric cancer outcomes may differ by demographic and socioeconomic characteristics even after taking clinical factors into consideration. This study evaluated predictors of late diagnosis, surgery receipt and post diagnosis survival among gastric cancer patients included in the National Cancer Data Base from 2004-2012.
Methods: The focus of these analyses was on the role of residence in metropolitan versus non-metropolitan areas. Separate multivariable logistic regression analyses were performed to evaluate the associations of residence with two outcomes: late stage cancer diagnosis and receipt of surgical procedure with curative intent. Multivariable Cox proportional hazards models were used to examine the association between survival and metropolitan residence status after controlling for various patient, disease, and treatment-related variables. Separate models were used for stages I-III.
Results: Patients residing metropolitan areas, those from non-metropolitan areas adjacent to metropolitan areas and those living in areas non-adjacent to metropolitan areas did not differ with respect to the likelihood of late diagnosis or surgery receipt. Associations between metropolitan residence and survival differed by disease stage. Among patients with stage III disease, the difference between metropolitan and non-metropolitan residence was significantly associated with worse survival with hazard ratios (95% confidence intervals) of 1.13 (1.03, 1.23) and 1.20 (1.06, 1.35), respectively, for residencies adjacent and non-adjacent to metropolitan areas.

Conclusions: These results indicate the possible underlying residence-based differences in survival among gastric cancer patients treated with surgery.

Table of Contents

BACKGROUND: 1


METHODS: 4


RESULTS: 8


DISCUSSION: 12


FUTURE DIRECTIONS: 14


REFERENCES: 16


TABLES: 19
Table 1. Characteristics of patients with gastric adenocarcinoma from the National Cancer Data Base, 2004-2012, stratified by patient's residence at the time of diagnosis (N = 37,092): 19
Table 2. Analysis of predictors of late stage (AJCC1 stage 3 or stage 4) diagnosis of gastric adenocarcinoma among patients from the National Cancer Data Base, 2004-2012 (N = 37,092): 20
Table 3. Analysis of predictors of receipt of any surgical procedure among patients with AJCC1 stage I-III gastric adenocarcinoma from the National Cancer Data Base, 2004-2012 (N = 34,673): 21
Table 4. Analysis of predictors1 of 60-month overall survival among patients with AJCC2 stage I, II, or III gastric adenocarcinoma with receipt of any surgical procedure from the National Cancer Data Base, 2004-2012 (N = 28,322): 22


FIGURES AND FIGURE LEGENDS: 23
Figure 1. The 60-month overall survival of patients with stage I-III gastric adenocarcinoma receiving surgical treatment of the primary site, as illustrated by metropolitan residence (National Cancer Data Base, 2004-2012): 23
Figure 2. The 60-month overall survival of patients with stage I-III gastric adenocarcinoma receiving surgical treatment of the primary site, as illustrated by race (National Cancer Data Base, 2004-2012): 23

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