An Estimation of the Population Survival Benefit of First-Line Chemotherapy for Upper Gastrointestinal Cancer. — ASN Events
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An Estimation of the Population Survival Benefit of First-Line Chemotherapy for Upper Gastrointestinal Cancer. (#1)

Viet Do 1 2 , Weng Ng 2 , Geoff P Delaney 2 , Michael B Barton 2
  1. Westmead Hospital, Westmead, NSW, Australia
  2. Collaboration for Cancer Outcomes Research & Evaluation, Ingham Institute for Applied Medical Research, University of NSW, Liverpool, NSW, Australia

Purpose: Randomized clinical trials and meta-analyses describe the benefit of chemotherapy and combined chemotherapy and radiotherapy for specific subgroups of major upper gastrointestinal (pancreas, oesophagus, stomach, liver and gallbladder) cancer patients with selected patient and disease characteristics. This study estimates the overall survival benefit for the whole population of upper gastrointestinal cancer patients in Australia if evidence-based guidelines for chemotherapy were followed.

Methods and Materials: Decision trees with evidence-based indications for chemotherapy have been previously defined [1]. Additional branches were defined in cases where new sub-groups benefit from chemotherapy. For all defined indications, the highest level of clinical evidence available was identified. Multiple electronic citation databases were systematically queried, including Medline and the Cochrane Library. In cases where there were multiple sources of the same level of evidence, hierarchical meta-analysis was performed. The benefits of chemotherapy were estimated for 1, 2 and 5-year survival. To assess the precision of our estimates, sensitivity analyses were performed.

Results: The estimated 1-year, 2-year, and 5-year absolute overall survival benefits of optimally utilized chemotherapy for upper gastrointestinal cancer in Australia are 7%, 2% and 1%, respectively. The overall survival benefits are summarized as followed:

Pancreatic cancer survival benefits: 1yr (9%), 2yr (2%) and 5yr (0%).

Oesophageal cancer survival benefits: 1yr (4%), 2yr (2%) and 5yr (1%)

Gastric cancer survival benefits: 1yr (5%), 2yr (1%) and 5yr (3%)

Liver cancer survival benefits: 1yr (5%), 2yr (1%) and 5yr (0%)

Gallbladder cancer survival benefits: 1yr (10%), 2yr (1%) and 5yr (1%)

Estimated total Upper Gastrointestinal Cancer Survival Benefits: 1yr (7%), 2yr (2%) and 5yr (1%)

Conclusion: Chemotherapy provides a modest survival benefit to the upper gastrointestinal cancer patient population in Australia when it is usedin accordance with guideline recommendations.