Impact of Prior Upper Endoscopy on Gastric Cancer Stage and Survival in Older Adults.
Academic Article
Overview
abstract
BACKGROUND AND AIMS: Gastric cancer outcomes remain poor in the US, with 36% 5-year survival and more than a third of cases diagnosed at an advanced stage. This study explores the impact of prior esophagogastroduodenoscopy (EGD) on gastric cancer stage at diagnosis and survival in an older Medicare-enrolled U.S. population. METHODS: The SEER-Medicare database was queried from 1999 to 2018 for gastric cancer patients 68 years of age or older with an EGD claim (Prior EGD) or without an EGD claim (No Prior EGD) 6-36 months prior to gastric cancer diagnosis. Comparing Prior EGD to No Prior EGD, logistic regression was used to estimate the odds of early-stage (in situ/local) and regional-stage versus distant-stage gastric cancer. Cox proportional hazard and Fine-Gray subdistribution hazard models were developed to estimate overall and gastric cancer-specific survival, respectively. RESULTS: In 15,871 patients with gastric cancer, 12.1% had Prior EGD (n=1,916). Patients with Prior EGD had a two-fold increased odds of early-stage gastric cancer compared with No Prior EGD (adjusted odds ratio [aOR]: 2.05; 95% confidence interval [CI]: 1.82-2.30). Compared with No Prior EGD, Prior EGD was associated with a lower hazard of death for overall (adjusted hazard ratio [aHR]: 0.78, 95% CI: 0.74-0.83) and cancer-specific (adjusted subdistribution hazard ratio [SHR]: 0.64, 95% CI: 0.64-0.69) survival. CONCLUSION: Prior EGD is associated with earlier stage and improved survival in older adults. This study supports further research into endoscopic screening in the U.S. across younger age groups and diverse populations and healthcare settings.
