Elderly Gastric Cancer Research Articles

Feasibility and Effectiveness of Gastrectomy for Elderly Gastric Cancer Patients

The benefits of gastrectomy for elderly gastric cancer (GC) patients remain unknown. The aim of this study was to evaluate the validity of gastrectomy. Patients who had R0 or R1 resection and diagnosed as pathological Stage I-III GC were enrolled in this study. Patients were classified according to age: Elderly group (≥80 years old), non-Elderly group (70-79 years old), Standard group (≤69 years old). As the age raised, the number of comorbidities increased and patients had a worse physical status. Operative procedure and postoperative complications of the Elderly group were similar to that of the non-Elderly group. The overall survival was similar in pathological Stages I and III between the Elderly and non-Elderly groups, while the Stage II Elderly group had shorter overall survival. Also, the Elderly group did not undergo adjuvant chemotherapy compared to other groups. Gastrectomy can be performed safely in elderly patients following gastrectomy, survival of elderly patients was similar to non-elderly patients. Therefore, gastrectomy is an acceptable treatment for elderly patients in good condition.

Controlling Nutritional Status (CONUT) Score Predicts Outcomes of Curative Resection for Gastric Cancer in the Elderly.

Preoperative nutritional status is considered to affect the short-term and long-term outcomes of cancer patients. The clinical value of the controlling nutritional status (CONUT) score in elderly patients undergoing gastrectomy for gastric cancer remains unknown. This study reviewed 211 elderly patients aged 75years or over who underwent curative resection for gastric cancer from 2000 to 2015. Patients were grouped according to the preoperative CONUT score into those with normal nutrition (75 patients), light malnutrition (100 patients) and moderate or severe malnutrition (36 patients). The predictive value of the CONUT score for postoperative morbidity and survival was assessed. Impaired nutrition was associated with cardiovascular disease (P = 0.012) and chronic kidney disease (P = 0.014), and worsened malnutrition was linked to advanced age (P = 0.004), decreased body mass index (P = 0.008) and advanced disease stage (P = 0.01). Multivariate analysis showed the CONUT score as an independent predictor of procedure-unrelated infectious morbidity (odds ratio, 2.36; 95% confidence interval [CI], 0.99-5.40; P = 0.046). Patients with a higher CONUT score had significantly shorter overall survival in both stage I and stage II/III gastric cancer (P = 0.044 and P = 0.007, respectively) and reduced cancer-specific survival in stage II/III (P = 0.003) The CONUT score was a strong predictors of overall survival (hazard ratio [HR], 2.12; 95% CI, 1.18-3.69; P = 0.012) and cancer-specific survival (HR, 3.75; 95% CI, 1.30-10.43; P = 0.015) independent of disease stage. The preoperative CONUT score is a simple and promising predictor of postoperative procedure-unrelated infectious morbidity and prognosis in elderly gastric cancer patients.

Clinical significance of serum pepsinogen and gastrin 17 in elderly gastric cancer

目的 研究血清胃蛋白酶原（PG）、胃泌素17（G-17）水平与胃癌的关系，评价其在胃癌筛查、病情评估和预后评估方面的价值。 方法 以2014年1月至2017年6月因消化道症状在合肥市第三人民医院消化内科行胃镜检查符合入选标准的170例患者为研究对象，根据组织病理学诊断结果分为非萎缩性胃炎组85例和胃癌组85例。采用酶联免疫吸附试验（ELISA）检测患者血清PGⅠ、PGⅡ和G-17水平，计算PGⅠ/PGⅡ比值（PGR）。对两组间计量数据比较采用t检验，多组间比较采用方差分析。 结果 非萎缩性胃炎组和胃癌组患者血清PGⅠ水平比较[（146±43）ng/ml比（149±55）ng/ml]，差异无统计学意义（t=0.821，P=0.414）。胃癌组患者血清PGⅡ水平高于非萎缩性胃炎组[（26±7）ng/ml比（17±7）ng/ml，t=2.359，P=0.020]，PGR低于非萎缩性胃炎组[（7±4）比（10±4），t=3.244，P=0.020]，G-17略升高，但与非萎缩性胃炎组比较[（11±7）pmol/L比（10±5）pmol/L]，差异无统计学意义（t=1.061，P=0.291）。不同性别的胃癌患者血清PGⅠ、PGⅡ水平差异有统计学意义（t=2.014，P=0.049；t=2.015，P=0.049）；不同病变部位、分化程度的胃癌患者G-17水平差异有统计学意义（F=5.398，P=0.002；F=9.516，P=0.000）；不同病变发生部位、TNM分期的胃癌患者PGR差异有统计学意义（F=2.218，P=0.092；t=2.167，P=0.036）。 结论 联合检查血清PG和G-17水平可用于胃癌的筛查，其对病情评估和预后评估有一定的帮助。

Elderly Gastric Cancer Patients with Myelodysplastic Syndrome

Elderly Gastric Cancer Patients with Myelodysplastic Syndrome

PS01.162: IS THERE A DIFFERENCE IN SURVIVAL BETWEEN YOUNGER AND OLDER GASTRIC CANCER (INCLUDING AEG II AND AEG III) PATIENTS AFTER GASTRECTOMY?

Abstract Background The incidence of gastric cancer decreases in the western world, however, it remains one of the most common diseases (1). There is just little data from Europe comparing the outcome of young and elderly gastric cancer patients. This study compares, depending on the age of 266 patients, the outcome of 266 consecutive gastrectomy cases due to gastric cancer Methods 266 consecutive patients with gastric cancer received a gastrectomy between 2008–2016 at our comprehensive cancer centre. The mean age of the patients in this study was 64 years old (21- 93 years). All patients were followed up regarding survival. The patients were separated in 6 different groups, depending on the age at the time of operation. The different groups were re-analysed and compared to each other regarding median and 5-year survival. Results In this collective the 5-year survival rate for all patients was 43%. There were more diffuse type adenocarcinomas in Patients < 40 years. In younger patients the tumour was staged in an advanced stadium compared to the elderly patients group. There is a significantly higher 5-year survival rate for younger patients after gastrectomy. There is no significant difference, when separating patient groups in to decades of age. Conclusion Young patients have a higher 5-year survival rate after gastrectomy compared to old patients. However, comparing patients from chronologic age in decades, the significance is not reproducible. Therefore gastrectomy or subtotal gastrectomy is the determining therapeutic approach for gastric cancer with an acceptable outcome in both young and elderly patients. Older patients might have an lower 5 year survival rate not only due to the cancer or the surgical therapy itself, it is related to comorbidities and a lower rate in neoadjuvant therapy as well Disclosure All authors have declared no conflicts of interest.

Changes in blood glucose of elderly patients with gastric cancer combined with type 2 diabetes mellitus after radical operation and the effect of mediation adjustment for blood glucose on the recovery of gastric cancer.

This study aimed to investigate the changes in blood glucose of elderly patients with gastric cancer combined with type 2 diabetes mellitus (T2DM) after radical operation. Forty-six patients in DM group and 30 patients in non-DM group underwent radical surgery between January, 2007 and January, 2017 in The First Hospital of Lanzhou University, and the clinical data were retrospectively analyzed. Statistical analysis was conducted to explore the effect of radical operation on blood glucose control of the two groups of patients. In 46 patients with gastric cancer combined with T2DM, 24 patients received postoperative insulin intervention, and the remaining 22 patients did not receive insulin intervention. This latter set of patients comprised the non-insulin treatment group. Blood glucose control conditions, inflammatory markers, tumor markers and their effects on the prognosis were compared between the two groups. Level of postoperative blood glucose of the DM group was significantly higher than that of the non-DM group (P<0.05), while the level of blood glucose in the insulin treatment group was significantly lower than that in the control group (P<0.05). Levels of related tumor markers and inflammatory factors of insulin treatment group were significantly higher than those of the control group (P<0.05). The 5-year survival rate of insulin treatment group was significantly higher than that of the control group (P<0.05). Our results showed that the level of blood glucose was significantly increased in elderly patients with gastric cancer combined with T2DM after radical operation, and levels of blood glucose, tumor markers and inflammatory factors in elderly gastric cancer patients with T2DM without insulin were significantly increased after radical operation, and long-term prognosis is poor.

Prognosis of elderly gastric cancer patients after surgery: a nomogram to predict survival.

This study aimed to identify clinicopathological factors associated with the outcome of elderly patients with gastric cancer (GC), and to construct a nomogram for individual risk prediction. Tumor characteristics of 143 patients aged ≥ 80years underwent surgery for GC were collected and analyzed by uni- and multivariate analyses. A prognostic nomogram was constructed using the factors which resulted to be significantly associated with overall survival. Discrimination of nomogram was tested by Kaplan-Meier (KM) curves and boxplots. With a median follow up of 18.37 months, overall 1-year survival rate was 51% and it was 60 and 40% for older and younger than 83 years, respectively (P = 0.003). Univariate analysis indicated that age (P = 0.008), pre-operatory performance status (P < 0.001), depth of invasion (P = 0.007), lymph nodes involvement (P < 0.001), and residual tumor (P < 0.001) were significant prognostic factors. Based on these variables, a nomogram to predict 3, 6, 12, and 24months survival probability after GC surgery was developed. KM and boxplots according to the range of nomogram total points highlighted the appropriateness of distinguish the patients' survival in all the subgroups. Moreover, this nomogram exhibited superior prognostic discrimination between intermediate stages (II-III) than AJCC-TNM classification. This study showed that after good surgical selection, the prognosis of elderly GC patients may be influenced by several clinicopathological factors. Therefore, a predictive nomogram to distinguish more accurately fit patients may allow physicians to individualize treatments and to detect those patients who may benefit from an intensive multidisciplinary approach.

Accumulation of T‑helper 22 cells, interleukin‑22 and myeloid‑derived suppressor cells promotes gastric cancer progression in elderly patients

Chronic inflammation and immunosuppression lead to aging and tumorigenesis. T-helper 22 (Th22) cells, interleukin 22 (IL-22) and myeloid-derived suppressor cells (MDSCs) serve an important role in inflammatory-immune diseases and cancer. However, the status of Th22 cells, IL-22 and MDSCs in aging and elderly gastric cancer progression is unknown. In the present study, 39 elderly patients with gastric cancer (EGC), 32 elderly healthy controls (HE) and 31 young healthy controls (HY) were enrolled, and the peripheral Th22, Th17 and Th1 cells, and MDSCs, were examined using flow cytometry. Plasma levels of IL-22, IL-6 and tumor necrosis factor-α (TNF-α) were examined using ELISA. IL-22 protein levels in tumor tissues were examined using immunohistochemistry. There were increased numbers of peripheral Th22 and Th17 cells, and MDSCs, as well as increased plasma levels of IL-22, IL-6 and TNF-α in EGC compared with HE and HY. However, HE exhibited significantly increased levels of peripheral Th22 and Th17 cells as well as IL-6 and TNF-α compared with HY. Immunohistochemical analysis demonstrated that IL-22 protein accumulated in tumor cells and lymphocytes in the tumor microenvironment. The results obtained demonstrated that peripheral Th22 and Th17 cells as well as IL-6 and TNF-α plasma levels increased with aging. Furthermore, Th22 and Th17 cells, MDSCs, and IL-22 may be used as prognostic markers for identifying gastric cancer in elderly patients.

Feasibility of Laparoscopy-assisted Gastrectomy for Gastric Cancer in Elderly Patients: A Case-Control Study.

The present study evaluated the safety and effectiveness of laparoscopic gastrectomy (LG) in elderly gastric cancer patients. This study included 78 gastric cancer patients aged 80 years or above [39 in the LG group and 39 in the open gastrectomy group (matched)]. Patient characteristics, surgical outcomes, survival time, and immunonutritional status were compared. Mean blood loss was significantly lower in the LG group, although the operation time did not differ. There were no significant differences in the number of dissected lymph nodes, postoperative morbidity, mortality, total hospital stay, and the causes of death. The prognostic nutritional index and skeletal muscle index at 1 year were better maintained in the LG group than in the open gastrectomy group. The overall and relapse-free survivals did not differ. LG may be feasible in elderly patients with gastric cancer. A prospective randomized controlled trial should be conducted to confirm its efficacy.

Surgical outcomes after gastrectomy in very elderly patients with gastric cancer.

Whether or not gastrectomy is feasible for very elderly gastric cancer patients is unclear. This study aimed to clarify the feasibility and safety of surgical treatment for patients in this age group. The study included 55 very elderly patients with resectable gastric cancer who underwent gastrectomy (≥ 85years of age; very-E group). The surgical outcomes were compared with those of 611 elderly patients (75-84years old; E group). Female sex, a poor physical and performance status, and a low serum albumin level patients were more frequent in the very-E group than in the E group. Lymphadenectomy was less aggressive in the very-E group than in the E group (P < 0.001). The overall postoperative complication rate was not significantly different between the groups (46 vs 33%; P = 0.073). A multivariate analysis to predict the overall survival identified male sex (hazard ratio 1.75, 95% confidence interval 1.30-2.36), low body mass index (2.19, 1.52-3.16), poor performance status (2.14, 1.60-2.86), low serum albumin level (1.84, 1.37-2.48), and advanced tumor stage (1.71, 1.29-2.27) but not age (1.31, 0.84-2.03) as independent prognostic factors. Chronological age alone is not a contraindicative factor for gastrectomy in very elderly patients.

Clinicopathological features and prognosis in elderly gastric cancer patients: a retrospective cohort study.

BackgroundLittle is known about the clinicopathological features and prognosis in elderly gastric cancer (GC) patients aged 65–79 years. The aim of this study was to evaluate clinicopathological features and prognosis in elderly GC patients.Patients and methodsFrom May 2008 to December 2014, a total of 5,282 GC patients were enrolled in our present study. Patients were divided into elderly and middle-aged groups. The clinicopathological features and clinical outcomes were analyzed.ResultsThe proportion of dysphagia was significantly higher in elderly patients than that in middle-aged patients (P=0.002), whereas the proportion of abdominal pain and heartburn was significantly lower in elderly patients than that in middle-aged patients (P<0.001 vs P=0.038, respectively). The proportion of patients with carbohydrate antigen (CA) 19-9 was significantly higher in elderly patients than that in middle-aged patients (P=0.009). There was no significant difference in clinicopathological features between elderly and middle-aged patients with D2 gastrectomy (all P>0.05). Age, tumor size, histological type, tumor depth, lymph node metastasis, carcinoembryonic antigen, alpha fetoprotein, CA19-9, and CA125 were independent risk factors for the prognosis of GC patients in univariate and multivariate analyses. Overall survival in elderly patients was significantly reduced compared with middle-aged patients (P=0.001), especially in patients with tumor size >5 cm (P=0.002), poorly differentiated tumor (P<0.000), stage III tumor (P=0.002), or normal levels of carcinoembryonic antigen (P=0.009), alpha fetoprotein (P=0.002), CA19-9 (P=0.002), and CA125 (P=0.004).ConclusionThe clinicopathological features of elderly patients were different to those of middle-aged patients. The prognosis for elderly GC patients was significantly worse than for middle-aged patients.

Outcomes of Laparoscopic Total Gastrectomy for Elderly Gastric Cancer Patients.

Purpose: The purpose of this study was to compare the short- and long-term outcomes after laparoscopic total gastrectomy (LTG) between elderly and non-elderly patients with gastric cancer.Methods: A retrospective analysis was performed using clinical and follow-up data from 168 patients treated with LTG for gastric cancer at our institution from January 2010 to December 2017. For this study, the short- and long-term outcomes (including tumor recurrence rate, disease-free survival rate, and overall survival rate) were compared between the elderly group (≥70 years) and non-elderly group (<70 years).Results: The preoperative American Society of Anesthesiologists score and Charlson Comorbidity Index were higher in the elderly group than in the non-elderly group, while there was no significant difference between the two groups in terms of operation duration, intraoperative blood loss, and rate of conversion to laparotomy. The incidence of postoperative 30-day complications in the elderly group was higher than that in the non-elderly group due to a higher incidence of pulmonary infection, while the incidence of major complications was similar in both groups. The tumor recurrence rate was also similar in both groups. There was no statistically significant difference between the two groups in terms of 5-year disease-free survival and 5-year overall survival rate.Conclusions: LTG is safe and feasible for elderly patients with gastric cancer and is associated with relatively good long-term outcomes.

Clinicopathological Characteristics and Prognoses of Elderly Gastric Cancer Patients after R0 Resection: A Multicenter Study in China.

The number of elderly gastric cancer (GC) patients has been rapidly increasing worldwide, but inadequate understanding regarding elderly GC patients has led to the paucity of appropriate treatment decisions. Our study evaluates clinicopathological characteristics and prognoses of elderly GC patients after R0 resection. Overall, 1877 consecutive GC patients who underwent R0 gastrectomy at four centers were enrolled. We divided patients into three groups according to age: young, middle, and elderly. We then analyzed clinicopathological characteristics and prognoses. Compared to the middle-aged group, the elderly group had a higher male-to-female ratio and number of patients with cardiac GC, trend of more advanced pathological stage, lower ratio of poor to moderate tumor grade, and fewer patients who received adjuvant chemotherapy or chemoradiotherapy. Moreover, 5 yr disease-free survival and overall survival rates of elderly patients were significantly less than those of middle-aged patients. A Cox analysis of middle-aged and elderly patients revealed that age and adjuvant chemotherapy were independent prognostic factors. Adjuvant chemotherapy improved long-term survival of elderly patients with stage III cancer. Elderly GC patients who underwent R0 resection had unique characteristics and poor long-term survival. We found that subjects should be stratified into the three aforementioned age groups when analyzing survival rates of GC patients. In addition, reasonable adjuvant treatment is recommended for elderly patients.

QUALITY OF LIFE IN THE ELDERLY PATIENTS AFTER SURGERY FOR GASTRIC CANCER

The problem of the quality of life of elderly gastric cancer patients after surgical treatment, is still insufficiently studied. Functional results of the management of 91 patients, underwent surgical treatment at the age of 75 years and older, are represented. 35 patients underwent gastrectomy, 56 patients - subtotal distal resection. The quality of life was assessed at the second year after surgery according to both the Performance Scales for the Karnofsky &amp; ECOG Scores, as well as the modified form of EORTC QLQ-STO 22. Only 40% of patients were fully recovered after total gastrectomy and 57.1% of cases - after gastric resection. 28.6% and 35.7% of patients respectively were incapable for full activity and required support. Patients with severe disability and cases needed a significant care amounted to 28.6% and 2.8% in the group of patients after gastrectomy and only 3.6% in the group of cases after the gastric resection. Thus, in elderly patients with gastric cancer after surgical treatment, a significant deterioration of the quality of life is observed, and therefore the tactic of minimization of the radical surgical intervention in this age group is reasonable.

Gait speed predicts post-operative medical complications in elderly gastric cancer patients undergoing gastrectomy.

Gait speed is a clinical outcome that can measure the physical performance of elderly gastric patients. The purpose of this study was to determine the importance of gait speed in predicting post-operative morbidities in elderly patients undergoing curative gastrectomy. We conducted a prospective study of 357 elderly patients (≥65 years old) undergoing curative gastrectomy. Preoperative gait speed was measured in a 6-m well-lit and unobstructed hallway. Patients were followed up for the post-operative clinical outcomes. Factors contributing to the post-operative morbidities were analysed using univariate and multivariate analyses. Slow gait speed was present in 95 out of 357 patients (26.61%) which was significantly associated with age (P < 0.001), gender (P = 0.016), plasma albumin (P < 0.001), American Society of Anesthesiologists grade (P = 0.012), tumour-node-metastasis grade (P = 0.007), sarcopenia (P < 0.001), handgrip (P < 0.001) and post-operative medical complications (P = 0.022). In univariate analysis, age (P = 0.015) and slow gait speed (P = 0.029) were risk factors of post-operative complications. In multivariate analysis, we found that age (P < 0.001) and slow gait speed (P = 0.029) were independent predictors of post-operative medical complications. Slow gait speed is an independent predictor of post-operative medical complications in elderly patients undergoing curative gastrectomy. Those patients should be managed with appropriate perioperative nutritional support and physical exercise which can improve gait speed and reduce the risk of post-operative medical complications.

Prevention and treatment of perioperative non-surgery-related complications in elderly patients with gastric cancer

The incidence of elderly gastric cancer patients is increasing, since the average life span is longer than ever before and the medical management is improved. Elderly patients usually have more comorbidities due to gradual loss of immunonutritional and functional status, leading to a higher rate of non-surgery-related postoperative morbidity and mortality. Along with the development of surgical and nursing technique, more and more surgeons would perform surgical procedures on elderly gastric cancer patients without hesitation. Moreover, recent studies showed that surgery would be an effective way to improve the prognosis of elderly gastric cancer patients, while the surgery-related complications were not increased significantly. Therefore, it is important to elucidate some specific issues of prevention and treatment of postoperative non-surgery-related complications in elderly gastric cancer patients. The topic of this review will cover coronary complications, pulmonary complications, nutrition-related complications, and some other postoperative issues.

Combined acupuncture and general anesthesia on immune and cognitive function in elderly patients following subtotal gastrectomy for gastric cancer.

This study investigated the effects of acupuncture combined with general anesthesia on postoperative immune and cognitive functions in elderly patients undergoing subtotal gastrectomy. We recruited 96 elderly patients who received anesthesia for subtotal gastrectomy and randomly divided them into control (n=48) and experimental (n=48) groups. The control group received general anesthesia and the experimental group received combined acupuncture and general anesthesia. We measured hemodynamic immediately before and after anesthesia induction, and immune observations before and after surgery. We found no significant differences in mean heart rate (HR), mean oxygen saturation (SpO2), and partial pressure of end-tidal carbon dioxide (PETCO2) in the perioperative period between the two groups. Mean arterial pressure (MAP) was lower in the experimental group than that in the control group (P<0.05). The levels of cluster of differentiation 3 (CD3+), CD4+ and CD4+/CD8+ in both groups were significantly lower after surgery in both groups (P<0.05). We also found some time-points in which the immune markers where significantly higher in the experimental group. In terms of adverse reactions, there were no differences in nausea, vomiting, and hypoxemia between the two groups (P>0.05), but the incidence of delayed recovery and postoperative agitation were significantly lower in the experimental group compared with those in the control group (P<0.05). One day after surgery, the experimental group showed better protection of cognitive function than the control group (P<0.05). Overall, combined acupuncture and general anesthesia in elderly gastric cancer patients receiving subtotal gastrectomy showed more stable hemodynamics and fewer stress responses during surgery. Thus, combined acupuncture and general anesthesia can shorten the recovery time from anesthesia, have less negative effects on immune function and decrease the incidence of postoperative cognitive impairment.

Hypermethylation of EIF4E promoter is associated with early onset of gastric cancer.

Although gastric cancer (GC) in young adults (≤ 45 years) accounts for fewer than 10% of newly diagnosed cases, the young patients are more likely to have advanced disease at presentation compared with elderly patients. Previous studies have identified that the DNA methylation of genomes are different during aging. Our study aimed to explore the association between DNA methylation and the onset of GC. We applied Illumina HumanMethylation450 BeadChip to examine methylation expression profiles and compared methylation expression patterns in five early onset GC patients and seven elderly patients. Additionally, we evaluated the associations of methylation expression with different clinicopathological characteristics of GC. Our results showed that the pattern of genome-wide methylation expression was significantly different between early onset and elderly GC. The top 10 hypomethylation and hypermethylation CpG sites were selected for further analyses in The Cancer Genome Atlas (TCGA) database. We found that the hypermethylation of cg11037477, located at the promoter of EIF4E, was significantly associated with age at diagnosis and the expression of EIF4E. Besides, GC patients with high level of cg11037477 were more likely to have advance disease with T3/T4 invasion and III/IV stage. The cg11037477 hypermethylation and EIF4E down-expression were significantly related to poor survival of GC patients. Our study provides new insights into the molecular mechanism of early onset patients with GC and suggests that methylation of cg11037477 and expression of EIF4E may act as prognostic markers in GC.

Long-term impact of postoperative pneumonia after curative gastrectomy for elderly gastric cancer patients.

With the extension of life expectancy, cancer has been increasing in elderly populations. Postoperative pneumonia can negatively influence immediate mortality following gastrectomy for elderly patients, but its impact on long‐term survival remains unclear. We retrospectively reviewed the cases of patients aged ≥75 years who underwent curative gastrectomy for gastric cancer from 2000 to 2014 to determine the long‐term effects of postoperative pneumonia and to identify independent risk factors along with physical status and surgical procedure. Of 250 patients, 32 (12.8%) developed postoperative pneumonia. Patients with postoperative pneumonia had significantly worse overall survival (OS) than those without postoperative pneumonia (P<.001). A multivariate analysis identified postoperative pneumonia as a prognostic factor for OS (hazard ratio, 2.06; 95% CI, 1.05‐3.75; P=.036). Significant risk factors for the development of postoperative pneumonia were male gender (P=.026) and D2 lymphadenectomy (P<.001). D2 lymphadenectomy was associated with poorer OS than D1 or D1+lymphadenectomy in patients with an American Society of Anesthesiologists (ASA) score 3 (P=.026), but did not influence OS negatively in patients with an ASA score ≤2. Limited lymphadenectomy did not affect the cancer‐specific survival of elderly patients with ASA score 3. Postoperative pneumonia following gastrectomy has an adverse impact on the long‐term survival of elderly gastric cancer patients. A limited lymphadenectomy during curative resection should be considered to prevent postoperative pneumonia in frail elderly patients with ASA score 3. Postoperative pneumonia following gastrectomy has an adverse impact on the long‐term survival of elderly gastric cancer patients. Extent of lymph node dissection during curative resection should be limited to prevent postoperative pneumonia, based on the patient's frailty.

Relationship between preoperative prognostic nutritional index and the effect of adjuvant chemotherapy and prognosis in elderly patients with gastric cancer

Objective To investigate the relationship between preoperative prognostic nutritional index(PNI) and prognosis in elderly patients with gastric cancer. Methods The clinical data of 62 patients over age 65 with gastric cancer who underwent radical gastrectomy for gastric cancer were retrospectively analyzed. PNI values were calculated and the relationship between PNI and untoward reactions and prognosis were discussed. Results PNI value is closely related with patient age(t=5.576, P<0.001), tumor size(χ2=4.846, P=0.033), lymphatic metastasis(χ2=13.742, P<0.001), preoperative CEA level(t=5.226, P<0.001). Among the 62 patients, 12 cases with high-PNI had recurrence and 5 patients died during the follow-up period, while 11 case in low-PNI had a recurrence and 7 patients died. The recurrent rate(χ2=4.055, P=0.044) and mortality rate(χ2=4.630, P=0.043) of the high-PNI group were significantly lower than the low-PNI group. Conclusion PNI is a simple and useful marker for predicting the long-term outcomes of elderly gastric cancer patients, which should be included in the routine assessment of gastric cancer patients. Key words: Nutrition assessment; Stomach neoplasms; Aged