Background: Resectable gastric and gastroesophageal junction cancer (GC/GEJC) treatment patterns in the real-world are poorly described. This study described real-world perioperative treatment and outcomes for patients in the US with resectable GC/GEJC. Methods: Data from the Flatiron Health Enhanced Datamart were analyzed for adult patients diagnosed with resectable GC/GEJC between 1 January 2016 and 1 January 2023. The primary objective was to describe perioperative treatments (neoadjuvant only, adjuvant only, both). Secondary objectives included real-world event-free survival (rwEFS) and real-world overall survival (rwOS). Results: Data from 1717 patients (901/816 with GC/GEJC) were included. Median age of patients with GC/GEJC was 68.0/69.0 years, 62.4%/83.3% were male, and 97.3%/96.7% had adenocarcinoma, respectively. For GC/GEJC, 71.1%/47.9% underwent surgery, of which 15.6%/70.1% received neoadjuvant treatment only, 26.4%/5.6% received adjuvant treatment only, 25.0%/17.4% received both, and 33.1%/6.9% received no perioperative treatment, respectively. For GC, the most frequent neoadjuvant treatment was FLOT (43.0% neoadjuvant only; 53.8% both) and the most frequent adjuvant treatments were chemoradiotherapy (39.6% adjuvant only) and FLOT (43.1% both). For GEJC, chemoradiotherapy was the most frequent neoadjuvant (66.4% neoadjuvant only; 67.6% both) and adjuvant only (54.5%) treatment. When patients received both, the most frequent adjuvant treatment was nivolumab (45.6%). For GC/GEJC, median rwEFS (95% CI) was 29.1 (24.7–38.7)/20.8 (17.4–23.7) months for patients who had planned or cancelled surgery and 11.3 (9.6–13.5)/12.7 (11.6–15.4) months for patients without planned surgery. Median rwOS (95% CI) was 50.9 (43.7–62.4)/38.6 (31.4–47.2) months for patients who had planned or cancelled surgery and 15.4 (13.1–18.6)/21.0 (17.6–22.6) months for patients without planned surgery. Conclusions: Real-world data showed lower use of perioperative treatments for resectable GC/GEJC than expected. rwEFS and rwOS remain poor. Optimization of perioperative treatments is needed to improve long-term outcomes.
背景：真实世界中可切除胃及胃食管结合部癌（GC/GEJC）的治疗模式尚缺乏充分描述。本研究旨在描述美国可切除GC/GEJC患者的真实世界围手术期治疗及临床结局。方法：分析Flatiron Health增强型数据集中2016年1月1日至2023年1月1日期间诊断为可切除GC/GEJC的成年患者数据。主要研究目标是描述围手术期治疗模式（仅新辅助治疗、仅辅助治疗、联合治疗）。次要目标包括真实世界无事件生存期（rwEFS）和真实世界总生存期（rwOS）。结果：共纳入1717例患者数据（GC/GEJC分别为901/816例）。GC/GEJC患者中位年龄分别为68.0/69.0岁，男性占比62.4%/83.3%，腺癌比例分别为97.3%/96.7%。在GC/GEJC患者中，接受手术者分别占71.1%/47.9%，其中仅接受新辅助治疗者占15.6%/70.1%，仅接受辅助治疗者占26.4%/5.6%，接受联合治疗者占25.0%/17.4%，未接受围手术期治疗者占33.1%/6.9%。GC患者中最常见的新辅助治疗方案为FLOT（仅新辅助治疗组43.0%；联合治疗组53.8%），最常见的辅助治疗方案为放化疗（仅辅助治疗组39.6%）和FLOT（联合治疗组43.1%）。GEJC患者中最常见的治疗方案为放化疗（仅新辅助治疗组66.4%；联合治疗组67.6%）和仅辅助治疗（54.5%）。在联合治疗组中，最常见的辅助治疗方案为纳武利尤单抗（45.6%）。对于GC/GEJC患者，计划或取消手术者的中位rwEFS（95% CI）分别为29.1（24.7-38.7）/20.8（17.4-23.7）个月，无手术计划者分别为11.3（9.6-13.5）/12.7（11.6-15.4）个月；计划或取消手术者的中位rwOS（95% CI）分别为50.9（43.7-62.4）/38.6（31.4-47.2）个月，无手术计划者分别为15.4（13.1-18.6）/21.0（17.6-22.6）个月。结论：真实世界数据显示可切除GC/GEJC的围手术期治疗应用率低于预期，rwEFS与rwOS仍不理想。需优化围手术期治疗方案以改善长期预后。
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