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Abstract
BackgroundThis study was conducted to assess the long-term outcomes of elderly patients among propensity-score-matched gastric cancer patients after curative gastrectomy and to propose the proper management of elderly gastric cancer patients.MethodsWe enrolled 626 patients with gastric cancer who underwent curative gastrectomy at our institution between January 2004 and December 2015. To minimize selection bias among 2 groups, propensity score matching was performed.ResultsPatients were divided into an elderly group over 75 years old (EP group; n = 186) and a non-elderly group (NEP group; n = 440). After propensity score matching, patients were divided into EP group (n = 178) and NEP group (n = 175). Five-year overall survival was significantly lower in the EP group than in the NEP group, consistent with a subgroup analysis of each stage. However, the 5-year disease-specific survival among all enrolled patients and those with stage I and II disease did not differ significantly. Moreover, in the subgroup of stage III patients, 5 year disease-specific survival was significantly lower in the EP group (23.0%) than in the NEP group (59.4%; P = 0.004). Because elderly patients with stage III disease had an extremely poor prognosis, we decided to compare the two groups with stage III. The EP group contained significantly fewer patients with D2 lymphadectomy (P = 0.002) and adjuvant chemotherapy (P < 0.001) than the NEP group. C-reactive protein to albumin ratio was significantly higher in patients in the EP group than in the NEP group (P = 0.046), and the prognostic nutritional index was significantly lower in patients in the EP group than in the NEP group (P = 0.045). Multivariate analysis revealed that the prognostic nutritional index and lymphatic invasion were independent prognostic factors.ConclusionsElderly gastric cancer patients with stage III disease showed poorer disease-specific survival compared with non-elderly patients, which may be due to a poorer nutritional and inflammatory background, fewer D2 lymphadenectomies, and a lack of adjuvant chemotherapy. The safe induction of standard lymphadenectomy and adjuvant chemotherapy with perioperative aggressive nutritional support may improve the prognosis of elderly gastric cancer patients with stage III disease.
Highlights
This study was conducted to assess the long-term outcomes of elderly patients among propensityscore-matched gastric cancer patients after curative gastrectomy and to propose the proper management of elderly gastric cancer patients
As for histology, the elderly patient (EP) group included more patients with differentiated-type carcinoma compared with the non-elderly patient (NEP) group (P = 0.005)
The EP group included significantly less patients with Charlson comorbidity index (CCI) low compared with the NEP group (P < 0.001), and modified frailty index (mFI) were significantly higher in patients in the EP group than in those in the NEP group (P < 0.001)
Summary
This study was conducted to assess the long-term outcomes of elderly patients among propensityscore-matched gastric cancer patients after curative gastrectomy and to propose the proper management of elderly gastric cancer patients. Surgeons sometimes have difficulties in deciding upon the surgery of elderly patients because elderly patients are poorly nourished and have a variety of comorbidities [3]. There are few studies evaluated outcomes after operation of gastric cancer in elderly patients, and whether lymph node dissection is associated with poor cancer prognosis is unclear. Despite the increase in elderly gastric cancer patient populations, there are few reports that indicate the efficacy of chemotherapy for elderly patients. The efficacy of limited lymph node dissection and adjuvant chemotherapy is unclear in patients with stage III disease where recurrence risk is high
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