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@ARTICLE{Huang:164264,
      author       = {L. Huang and L. Jansen$^*$ and Y. Balavarca$^*$ and R. H.
                      A. Verhoeven and J. P. Ruurda and L. Van Eycken and H. De
                      Schutter and J. Johansson and M. Lindblad and T. B.
                      Johannesen and V. Zadnik and T. Žagar and M. Mägi and E.
                      Bastiaannet and S. M. Lagarde and C. J. H. van de Velde and
                      P. Schrotz-King$^*$ and H. Brenner$^*$},
      title        = {{D}ecreasing resection rates for nonmetastatic gastric
                      cancer in {E}urope and the {U}nited {S}tates.},
      journal      = {Clinical and translational medicine},
      volume       = {10},
      number       = {6},
      issn         = {2001-1326},
      address      = {Heidelberg [u.a.]},
      publisher    = {Springer Open},
      reportid     = {DKFZ-2020-02350},
      pages        = {e203},
      year         = {2020},
      note         = {#EA:C070#LA:C070#},
      abstract     = {Resection is the cornerstone of curative treatment for many
                      nonmetastatic gastric cancers (GCs), but the population
                      treatment patterns remains largely unknown. This large
                      international population-based study aimed at investigating
                      the treatment patterns and trends for nonmetastatic GC in
                      Europe and the United States and at exploring factors
                      associated with resection.Data of patients with
                      microscopically confirmed primary invasive GC without
                      distant metastasis from the national cancer registries of
                      the Netherlands, Belgium, Sweden, Norway, Slovenia, and
                      Estonia and the US Surveillance, Epidemiology, and End
                      Results (SEER)-18 Program were retrieved. Age-standardized
                      treatment rates were computed and trends were evaluated
                      using linear regression. Associations of resection with
                      patient and tumor characteristics were analyzed using
                      multivariable-adjusted log-binomial regression. Analysis was
                      performed in each country respectively without
                      pooling.Together 65 707 nonmetastatic GC patients diagnosed
                      in 2003-2016 were analyzed. Age-standardized resection rates
                      significantly decreased over years in all countries (by
                      $4-24\%).$ In 2013-2014, rates varied greatly from 54 to
                      $75\%.$ Patients with increasing ages, cardia cancers, or
                      cancers invading adjacent structure were significantly less
                      frequently resected. Resection was further associated with
                      sex, performance status, comorbidities, tumor histology,
                      tumor size, hospital type, and hospital volume. Association
                      patterns and strengths varied across countries. After
                      multivariable adjustment, resection rates remained
                      decreasing (prevalence ratio = 0.97-0.995 per year), with
                      decreasing trends consistently seen in various
                      subgroups.Nonmetastatic GCs were less frequently resected in
                      Europe and the United States in the early 21st century.
                      Resection rates varied greatly across countries and appeared
                      not to be optimal. Various factors associated with resection
                      were revealed. Our findings can help to identify differences
                      and possibly modifiable places in clinical practice and
                      provide important novel references for designing effective
                      population-based GC management strategies. In Europe and the
                      United States, nonmetastatic gastric cancers were less
                      frequently resected in the early 21st century. Resection
                      rates varied greatly across countries and appeared not
                      optimal. Various factors associated with resection were
                      revealed. Our findings identify differences and possibly
                      modifiable places in clinical practice and provide important
                      novel references for designing effective population-based
                      management strategies.},
      cin          = {C070 / C120 / HD01},
      ddc          = {610},
      cid          = {I:(DE-He78)C070-20160331 / I:(DE-He78)C120-20160331 /
                      I:(DE-He78)HD01-20160331},
      pnm          = {313 - Cancer risk factors and prevention (POF3-313)},
      pid          = {G:(DE-HGF)POF3-313},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:33135354},
      doi          = {10.1002/ctm2.203},
      url          = {https://inrepo02.dkfz.de/record/164264},
}