An Estimation of the Population Survival Benefit of First-line Chemotherapy for Upper Gastrointestinal Cancer (#306)
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. They are summarized in the below table.
Upper Gastrointestinal Cancer Estimation of Population Survival Benefit of First-line Chemotherapy Total proportion of upper GIT cancer population (excluding small bowel and biliary tract cancer)
1-yr survival benefit 2-yr survival benefit 5-yr survival benefit
Pancreatic cancer 9% 2% 0% 34%
Oesophageal cancer 4% 2% 1% 17%
Gastric cancer 5% 1% 3% 25%
Liver cancer 5% 1% 0% 15%
Gallbladder cancer 10% 1% 1% 9%
Upper GIT Cancer 7% 2% 1% 100%
Conclusion: Chemotherapy provides a modest survival benefit to the upper gastrointestinal cancer patient population in Australia when it is in accordance with guideline recommendations.
- Ng, W., Estimating the optimal chemotherapy utilisation rate as an evidence-based benchmark in cancers of the breast, upper gastrointestinal tract, gynaecological tract, head and neck, kidney, bladder, thyroid and unknown primary., in University of NSW, Faculty of Medicine2010, UNSW: Sydney.