The Application Status And Clinical Value Of The NCCN Guideline For Gastric Cancer Patients In A Comprehensive Teaching Hospital In Shanghai

Background and objectiveGastric cancer is one of the most common malignant tumors in China, with fairly high incidence and mortality. In order to standardize the treatment and improve the prognosis of patients, several guidelines have been published. And the NCCN guideline is one of the most influential guidelines worldwide. This study retrospectively analyzed the clinical data of gastric cancer patients in a comprehensive teaching hospital in Shanghai, preliminarily understood the characters of clinical features of patients. It also evaluated the compliance to the NCCN guideline, and detected its clinical value by analyzing whether complying with the NCCN guideline had an impact on patients’survival.MethodsIn the two periods, from January2003to December2004and from January2008to June2009, the clinical data of gastric cancer patients treated in a comprehensive teaching hospital in Shanghai were reviewed. The patient inclusion criteria were as follows:(1) pathologically confirmed gastric cancer;(2) TNM stage is available.The compliance of patients’treatment in2003-2004and2008-2009period with the NCCN guideline (respectively with version2002and version2007) was evaluated. And the overall ratio of patients whose treatment complied with the NCCN guideline version2010was evaluated. Then, it was analyzed whether complying with the NCCN guideline had an impact on patients’survival, and prognosis factors analysis was analyzed. In addition, the clinical value of the NCCN guideline version2010was also judged.The clinical characteristics and survival data were collected. Kaplan and Meier method was used to do the survival analysis in the whole cohort. The differences between the Kaplan-Meier curves were determined with the log-rank test. The prognostic factors found of borderline significance were included in a multivariate analysis, performed with the Cox proportional hazards model. Significance was reported for a P value<0.05. All statistical analyses were performed under SPSS17.0computer package. Results1.916patients met the patient inclusion criteria. Follow-up was obtained in758cases, and the dropout rate was17.2%.2. Upper abdominal pain was the most common symptom and upper abdominal tenderness was the most common sign. A majority of the lesions located in non-proximal stomach. Advanced gastric cancer placed with88.1%at initial diagnosis. The most common metastasis sites of patients in stage M1was liver and abdominal-pelvic cavity plantation metastases.3. The compliance rate with the NCCN guideline in these two periods was11.3%and22.5%, respectively. With time ongoing, the compliance rate significantly increased. The ratio of all patients whose treatment complied with the NCCN guideline version2010was39.1%.4. The fact that patients always received radical surgery with adjuvant chemotherapy, rather than with adjuvant chemoradiation might cause the low compliance rate with the NCCN guideline version2002and version2007. However, it complied with the NCCN guideline version2010.5. Complying with the NCCN guideline version2010was one independent prognosis factor for gastric cancer patients.6. For patients in stage Tis-T1NOMO and T2NOMO without high risks, adjuvant chemotherapy was not beneficial. For patients in stage Tis-TINOMO and T2NOMO without high risks, D2radical surgery didn’t show survival advantage (compared with D1). For patients in stage T≥2or TxN+, MO who received D2radical surgery, improved overall survival was associated with enough course (≥6cycles) of adjuvant chemotherapy.7. Those patients in stage M1who received palliative chemotherapy (palliative chemotherapy±palliative surgery) had higher survival rate than those not (palliative surgery or supportive care only).Conclusions1. The compliance rate with the NCCN guideline version2002and version2007was low. With time ongoing, it significantly increased. 2. For patients in stage Tis-T1NOMO and T2NOMO without high risks, Dl radical surgery was enough (D2radical surgery was unnecessary). In addition, adjuvant chemotherapy was unnecessary. For patients in stage T≥2or TxN+, MO, enough course (≥6cycles) of adjuvant chemotherapy had survival favor. For patients in stage M1who had relatively better performance status, palliative chemotherapy was beneficial.3. The NCCN guideline version2010was more suitable to gastric patients’treatment in this hospital.