我们使用了一种新颖的综合分析方法来评估与非转移性胃癌手术切除失败有关的各种因素。我们在公开可得的胃癌临床试验数据以及国家癌症数据库（NCDB）中识别了与接受手术有关的因素，以及与I-III期胃腺癌患者有关的因素。接下来，我们评估了在NCDB中预测接受手术的变量重要性。在已发表的临床试验数据中，10％的手术组患者未接受手术，主要是由于疾病进展，而新辅助治疗组的患者中有15％未进行手术。与新辅助治疗有关的影响解释了增加的退化率（5％）。在NCDB中，61.7％的患者接受了决定性手术。在一组类似于临床试验入组患者（年轻，健康，私人保险，治疗在高卷和学术中心）的NCDB患者中，手术率为79.2％。手术概率降低与年龄增长（OR 0.97，p <0.01），Charlson-Deyo评分为2+（OR 0.90，p <0.01），T4肿瘤（OR 0.39，p <0.01），N +疾病（OR 0.84，p <0.01），低社会经济地位（OR 0.86，p = 0.01），未投保或在医疗补助中（OR分别为0.58和0.69，p <0.01），低设施卷数（OR 0.64，p <0.01）和非学术肿瘤计划（OR 0.79，p <0.01）有关。审查临床试验结果显示不可避免的肿瘤和治疗因素造成了15％的退化。NCDB表明了与患者和提供者特征无关（即年龄，保险状态，机构卷数）的退化率。这种综合分析强调了改善可能的治愈手术率的具体机会。© 2023年外科肿瘤学会。

We used a novel combined analysis to evaluate various factors associated with failure to surgical resection in non-metastatic gastric cancer.We identified factors associated with the receipt of surgery in publicly available clinical trial data for gastric cancer and in the National Cancer Database (NCDB) for patients with stages I-III gastric adenocarcinoma. Next, we evaluated variable importance in predicting the receipt of surgery in the NCDB.In published clinical trial data, 10% of patients in surgery-first arms did not undergo surgery, mostly due to disease progression and 15% of patients in neoadjuvant therapy arms failed to reach surgery. Effects related to neoadjuvant administration explained the increased attrition (5%). In the NCDB, 61.7% of patients underwent definitive surgery. In a subset of NCDB patients resembling those enrolled in clinical trials (younger, healthier, and privately insured patients treated at high-volume and academic centers) the rate of surgery was 79.2%. Decreased likelihood of surgery was associated with advanced age (OR 0.97, p < 0.01), Charlson-Deyo score of 2+ (OR 0.90, p < 0.01), T4 tumors (OR 0.39, p < 0.01), N+ disease (OR 0.84, p < 0.01), low socioeconomic status (OR 0.86, p = 0.01), uninsured or on Medicaid (OR 0.58 and 0.69, respectively, p < 0.01), low facility volume (OR 0.64, p < 0.01), and non-academic cancer programs (OR 0.79, p < 0.01).Review of clinical trials shows attrition due to unavoidable tumor and treatment factors (~ 15%). The NCDB indicates non-medical patient and provider characteristics (i.e., age, insurance status, facility volume) associated with attrition. This combined analysis highlights specific opportunities for improving potentially curative surgery rates.© 2023. Society of Surgical Oncology.