Abstract
BackgroundA phase III clinical trial has already shown the survival benefits of postoperative chemotherapy in gastric cancer. However, there are limited published data concerning the elderly. This study aims to investigate the use of adjuvant chemotherapy for gastric cancer after D2 gastrectomy among the elderly and identify its impact on survival.MethodsWe retrospectively reviewed 360 patients who had undergone D2 gastrectomy, aged 65 years or older, with non-metastatic gastric cancer in a single institution. We analyzed the predictors and survival benefits of adjuvant chemotherapy use in the elderly. Further, we analyzed the survival benefits of adjuvant chemotherapy by dividing the patients into groups according to disease stages and chemotherapeutic regimens.ResultsAmong the 360 patients, only 34.7% of patients received adjuvant chemotherapy. Age, tumor location, lymph node involvement and tumor invasion were associated with the receipt of adjuvant chemotherapy. Adjuvant chemotherapy improved the overall survival for non-metastatic elderly patients (HR 0.60, 95%CI 0.42–0.83, P = 0.003). Significant survival benefits were found with adjuvant chemotherapy in stage III patients (HR 0.67, 95%CI 0.47–0.97, P = 0.033), but not in stage I patients or in stage II patients (HR 0.52, 95%CI 0.21–1.30 P = 0.161). Compared to adjuvant chemotherapy without platinum, no significant survival benefits were observed with platinum-containing chemotherapy (HR 0.84, 95%CI 0.49–1.45, P = 0.530). Besides adjuvant chemotherapy, other independent prognostic factors of survival included tumor location, tumor size, histologic grade, depth of tumor invasion, and lymph node status.ConclusionsThis study demonstrated the survival benefits of adjuvant fluoropyrimidine-based chemotherapy among the elderly patients with non-metastatic gastric cancer after D2 gastrectomy. However, due to the limitations of this study, further well-designed prospective studies with large populations are needed to confirm these findings and identify the patients that can tolerate and benefit from adjuvant chemotherapy.
Highlights
As the second leading cause of cancer-related death worldwide, gastric cancer is a health threat
This study aims to investigate the use of adjuvant chemotherapy among patients aged 65 years or older with non-metastatic gastric cancer after D2 gastrectomy in a single center and explore the survival benefits from chemotherapy
Significant survival benefits were found with adjuvant chemotherapy in stage III patients (HR 0.67, 95%confidence interval (CI) 0.47–0.97, P = 0.033), but not in stage I patients or in stage II patients
Summary
As the second leading cause of cancer-related death worldwide, gastric cancer is a health threat. The only available treatment to cure gastric cancer is surgical resection, but the prognosis of the patients that have received radical resection is still poor. Adjuvant therapy is considered to improve the survival for patients with curative gastric resection. The U.S Intergroup study(INT-0116) and the United Kingdom Medical Council MAGIC trial showed survival benefits from postoperative chemoradiotherapy and perioperative chemotherapy, respectively [4,5]. Most of the gastrectomy procedures in both studies were limited to D0 or D1 resections, while D2 resection only comprised about 10% of the cases. A phase III clinical trial has already shown the survival benefits of postoperative chemotherapy in gastric cancer. This study aims to investigate the use of adjuvant chemotherapy for gastric cancer after D2 gastrectomy among the elderly and identify its impact on survival
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