Objective:

2

To describe the treatment patterns and survival status of advanced gastric cancer (AGC) in China in the past two decades

and objectively evaluate the impact of standardized Chinese medicine (CM) treatment on the survival of AGC patients.

Methods:

2

This multicenter registry designed and propensity score analysis study described the diagnosis characteristics

treatment-pattern development and survival status of AGC from 10 hospitals in China between January 1

2000 and July 31

2021. Overall survival (OS) was evaluated between non-CM cohort (standard medical treatment) and CM cohort (integrated standard CM treatment ≥3 months). Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were performed to adjust any difference in average outcomes for bias.

Results:

2

A total of 2

001 patients histologically confirmed locally advanced and/or metastasis stomach and gastroesophageal junction adenocarcinoma were enrolled. Among them

1

607 received systemic chemotherapy

215 (10.74%) accepted molecular targeted therapy

44 (2.2%) received checkpoint inhibitor therapy

and 769 (38.43%) received CM. Two-drug regimen was the main choice for first-line treatment

with fluoropyrimidine plus platinum as the most common regimen (530 cases

60.09%). While 45.71% (16 cases) of patients with HER2 amplification received trastuzumab in first-line. The application of apatinib increased (33.33%) in third-line. The application of checkpoint inhibitors has increased since 2020. COX analysis showed that Lauren mixed type (

P

=0.017)

cycles of first-line treatment

>

6 (

P

=0.000)

CM (

P

=0.000)

palliative gastrectomy (

P

=0.000)

trastuzumab (

P

=0.011)

and apatinib (

P

=0.008) were independent prognostic factors for the OS of AGC. After PSM and IPTW

the median OS of CM cohort and non-CM cohort was 18.17 and 12.45 months

respectively (

P

<

0.001).

Conclusions:

2

In real-world practice for AGC in China

therapy choices consisted with guidelines. Two-drug regimen was the main first-line choice. Standardized CM treatment was an independent prognostic factor and could prolong the OS of Chinese patients with AGC. (Registration No. NCT02781285)