Relationship between age and the time of surgery and prognosis after gastrectomy for gastric cancer

Computational Analysis of the Related Factors of Deep Vein Thrombosis (DVT) Formation in Patients Undergoing Hip Fracture Surgery

A retrospective study was conducted on 51 patients undergoing hip fracture surgery to investigate the factors associated with the formation of deep venous thrombosis (DVT). The independent sample t-test and correlation analysis were used to sort out and analyze the data. The findings are as follows. (1) Different gender samples showed significant differences in the Caprini score and thrombus location. Most DVTs in females are located in the posterior tibial vein and intermuscular veins. The Caprini score of females was significantly higher than that of males. (2) Age displays a positive correlation with DVT, coronary heart disease, hypertension, and different surgical types, respectively. (3) There is a correlation between age and operation duration. (4) Hyperlipidemia and cerebrovascular disease show a positive correlation with DVT. (5) There was a significant negative correlation between the Caprini score and the quantification of D-dimer. This indicates that in this sample, the higher the patients' Caprini score is, the lower the quantitation of D-dimer will be. (6) Hyperlipidemia and cardiac insufficiency show a positive correlation with cerebrovascular disease. Patients with hyperlipidemia and cardiac insufficiency may also suffer from cerebrovascular diseases.

Preceding endoscopic submucosal dissection in submucosal invasive gastric cancer patients does not impact clinical outcomes

Submucosal deep invasion of gastric cancer (T1b2; depth of submucosal invasion ≥ 500 μm) is a risk factor for lymph node metastasis and, thus, is one of the criteria for curative treatment. Our aim was to evaluate the specific influence of endoscopic submucosal dissection (ESD) on the prognosis of patients with T1b2 gastric cancer. This was a retrospective analysis of 248 consecutive patients, with 252 pT1b2 gastric cancer lesions, who underwent ESD prior to additional surgery (Group A, n = 101) or surgery only (Group B, n = 147). After propensity score-matching (for sex, age, tumor diameter and gross type), we compared pathological characteristics between the 2 groups and the prognosis over a follow-up period ≥ 60 months. Compared to Group B, patients in Group A were older, with a higher proportion of men. The proportion of depressed and undifferentiated type tumors was greater in Group B than A, with larger tumor size and depth of submucosal invasion as well. There was no incidence of local recurrence, but distant metastasis was identified in 5% of cases in Group A and 3% in Group B. After propensity score-matching, there were no difference in the 5-year overall survival rate between Group A and B (87.5% vs. 91.2%, respectively), nor in the 5-year disease-specific survival rate (96.3% vs. 96.4%, respectively). ESD prior to surgery for T1b2 gastric cancer did not adversely affect clinical outcomes after additional surgery.

The role of surgery in patients aged 85 years or older with resectable gastric cancer: a propensity score matching analysis of the SEER database

Introduction: An increasing number of newly diagnosed resectable gastric cancer (GC) patients are over 85 years of age. However, studies on surgical treatment in these patients are limited. This study aimed to explore the prognosis of a large sample of the oldest old GC patients receiving surgery.Methods: A total of 2914 oldest old patients with stage I-III GC were included in the linked Surveillance, Epidemiology, and End Results (SEER) database from 2006 to 2015. Based on their treatment, we assigned these patients to the surgery and no surgery groups. We used propensity score matching (1:1) to balance the baseline characteristics. The Kaplan-Meier method was used for the survival analysis. Multivariate Cox regression analysis was used to analyse the independent risk factors.Results: After propensity score matching, the median overall survival (OS) times in the surgery and no surgery groups were 24.0 (95% CI: 20.3-27.7) and 4.0 (95% CI: 3.5-4.5) months, respectively (p < .01). Age, sex, stage, histological type, and treatment with surgery and chemotherapy were independent risk factors for OS in the oldest old patients with GC. In total, 19% of the oldest old patients with GC died from causes unrelated to cancer.Conclusions: The current large-scale study demonstrated that the oldest old patients with stage I-III GC could benefit from elective surgery.

Association of the age-adjusted Charlson Comorbidity Index and systemic inflammation with survival in gastric cancer patients after radical gastrectomy

PURPOSE

To examine the associations of the Age-Adjusted Charlson Comorbidity Index (ACCI) and preoperative systemic inflammation with survival in gastric cancer (GC) patients who underwent radical gastrectomy.

METHODS

Data from patients with GC who underwent radical gastrectomy between January 2009 and December 2014 in Fujian Medical University Union Hospital were retrospectively analyzed. Univariate and multivariate Cox regression analyses were performed to identify the prognostic factors. The relationship between the ACCI and systemic inflammation of the patients was explored, and the prognostic value of a new scoring system based on the ACCI and systemic inflammation (ANLR) was evaluated.

RESULTS

A total of 2257 patients with GC were included. The ACCI and neutrophil to lymphocyte ratio (NLR) were independent prognostic factors for overall survival (both P < 0.001) by multivariate analysis. A higher ACCI was an independent predictor of the increase in preoperative NLR (P < 0.001). Based on the preoperative ACCI and NLR, we established a novel marker, ANLR. Multivariate analysis showed that the ANLR was a significant independent predictor of 5-year OS (P < 0.001). The Harrell's C-statistics (C-index) of a model combining the ANLR and pTNM was 0.744 (95% CI: 0.728-0.760), which was significantly higher than the pTNM stage (0.717, 95% CI: 0.702-0.731; P < 0.001).

CONCLUSION

The ACCI of patients with gastric cancer was associated with preoperative systemic inflammation. The ACCI combined with the NLR, which are commonly collected biomarkers, could enhance prognostication for GC patients.

Analysis of the Clinicopathological Characteristics of Gastric Cancer in Extremely Old Patients

PURPOSE

Gastric cancer is the third-leading cause of cancer-related death in Korea. As the Korean population is ageing, the number of extremely old patients with this disease is increasing. This study examined the clinicopathological characteristics of gastric cancer in extremely old (over 85 years) patients who received treatment or conservative observations and compared the treatment outcomes according to the treatment modality.

MATERIALS AND METHODS

A total of 170 patients over 85 years of age were diagnosed with gastric cancer. Of these, 81 underwent treatment for gastric cancer and 89 received conservative observations. The clinicopathological characteristics of the treatment and conservative groupswere compared.

RESULTS

The mean age of the patients was 86.5 years. The conservative group included significantly more patients with older ages, macroscopically advanced cancer and upper-middle located cancer. The overall survival rate of the treatment group was significantly higher than that of the conservative group. The disease-specific mortality rate was significantly lower in the treatment group than in the conservative group. Multivariate analysis revealed the clinical course, alarm sign, and macroscopic classification to be independent prognosis factors.

CONCLUSION

By itself, the chronological age should not be used as a strategy to determine whether treatmentwill be administered for gastric cancer. Patients who have early gastric cancer or lower-risk preexisting comorbidities should not be discouraged from treatment, even if they are older than 85 years.

Effect of additional surgery after noncurative endoscopic submucosal dissection for early gastric cancer

BACKGROUND AND STUDY AIMS

Endoscopic submucosal dissection (ESD) is a standard treatment for early gastric cancer (EGC) without lymph node metastasis. However, some patients undergo noncurative ESD. The aim of the present study was to assess the long-term clinical outcomes of noncurative ESD with or without additional surgery.

PATIENTS AND METHODS

We investigated the chart data from all patients who had undergone ESD for EGC at Saga Medical School Hospital and Saga Prefectural Medical Centre Koseikan between 2001 and 2012. A total of 957 cases (1047 lesions) of EGC underwent ESD, and 99 had noncurative ESD. In total, 20 cases were excluded because their follow-up period was < 3 years. We divided the patients into observation and additional surgery groups, and we compared the survival rate and related factors between the groups.

RESULTS

After noncurative ESD, 28 /79 patients (35.4 %) underwent additional surgery and 51/79 (64.6 %) were followed up without surgery. The average age of patients in the observation group was higher than that of the additional surgery group (75.9 vs. 71.6 years; P = 0.03). The incidence of hypertension was significantly higher in the observation group compared with the additional surgery group (51.0 vs. 25.9 %; P = 0.03). The overall survival rate of the additional surgery group was longer than that of the observation group. However, only one patient died from gastric cancer in the observation group. The disease-specific survival rate did not differ significantly between the groups.

CONCLUSIONS

It might be acceptable to follow up without additional surgery for some patients with comorbidity and who were elderly after noncurative ESD for EGC.

A retroperitoneal NF1-independent malignant peripheral nerve sheath tumor with elevated serum CA125: case report and discussion

Malignant peripheral nerve sheath tumors (MPNSTs) are usually located in the trunk, extremities, head, or neck, and most occur with neurofibromatosis type 1 (NF1; von Recklinghausen's disease). No biomarkers have previously been found to be associated with their progression. Retroperitoneal NF1-independent MPNSTs are rare; they are considered to be less aggressive and to have better prognoses compared to NF1-related tumors. Currently, en bloc excision is the only consensus treatment approach. In a 27-year-old male with a giant retroperitoneal MPNST and no stigmata or family history of neurofibromatosis type-1 (NF1), a remarkable elevation of serum CA125 was detected. The high-grade tumor displayed a striking progression: the primary lesion, 25 cm in diameter, recurred in its previous site as a 17-cm MPNST less than 50 days after total excision. Subsequent treatment with microwave ablation and huachansu, a traditional Chinese medication, proved ineffective, and the patient died within 3 months. Our case suggests that retroperitoneal MPNSTs can deteriorate rapidly even if NF1 independent, that aggressive treatment may not benefit large high-grade MPNSTs, and that novel and effective treatment is urgently needed. Our case also suggests the possibility of using serum tumor markers in the early detection and monitoring of MPNSTs.

Gastroesophageal junction adenocarcinoma of young patients who underwent curative surgery: a comparative analysis with older group

PURPOSE

Adenocarcinoma of the stomach at a young age has a poor prognosis, but there are few reports describing gastroesophageal junction adenocarcinoma. This study aimed to compare the clinicopathological characteristics between the young and old patients who underwent curative surgery.

METHODS

One thousand three hundred and sixty-one patients with gastric adenocarcinoma underwent a curative gastrectomy between January 1, 1992 and December 31, 2006. Of these, 141 (10.4%) cases were gastroesophageal junction adenocarcinoma according to the Siewert's classification, and the data were collected prospectively for the analysis of the young age group (under 44 years old), in comparison to the older age group, with factors such as pathological characteristics, recurrence, and survival.

RESULTS

The sex ratio was near 1:1 in the younger group while it was predominantly male in the older group. There were no significant differences in the clinicopathological characteristics, such as the recurrence and survival rate, between the two groups.

CONCLUSIONS

The factor of young age does not critically affect the clinical course of gastroesophageal junction adenocarcinoma. This may be attributed to curative surgery and multimodality therapy.

Clinicopathological aspects and prognostic value with respect to age: an analysis of 3,362 consecutive gastric cancer patients

BACKGROUND AND OBJECTIVES

Several studies have reported controversial results about clinicopathological features and prognoses in gastric cancer patients with respect to age, partly due to variable definitions of young age and inhomogeneity of the patient population. The aim of study was to analyze clinicopathological features and prognostic value of all stages of gastric cancer in a large consecutive series.

METHODS

Between 2000 and 2005, 3,362 patients with all stages of gastric cancer were enrolled in database. Patients were divided into three groups: group 1 (< or =45), group 2 (46-70), and group 3 (> or =71).

RESULTS

Upper location and linitis plastica were more frequent in group 1. Young patients had a higher proportion of poorly differentiated and signet ring cell type with elevated CA19-9 level. Depressed type was more frequent in early gastric cancer (EGC) while Bormann type IV and Lauren diffuse type were more common in AGC in group 1. In curatively resected patients, a 5-year survival rate was significantly higher in group 1 than older groups. Stage, vein invasion, curative resection, and CA19-9 level were significant prognostic factors in all gastric cancer.

CONCLUSIONS

Clinicopathological features associated with young gastric cancer include upper location, linitis plastica, histopathologically diffuse type, and unresectability.

Decisions for extent of gastric surgery in gastric cancer patients: younger patients require more attention than the elderly

BACKGROUND AND OBJECTIVES

There is a prevailing belief that young patients with gastric adenocarcinomas have a more aggressive disease.

METHODS

We reviewed the prospectively collected database of 753 gastric adenocarcinomas patients who had undergone curative gastrectomy. Clinicopathological factors and the survival rates for each pathological TNM stage were compared between patients younger than 40 years of age and the others.

RESULTS

Fifty-four (9.8%) patients were younger than 40 years of age. The overall accuracy of the intra-operative stage was 62.5%; 54.0% in the young patients and 63.5% in older patients (P = 0.006). Intraoperative under-staging was more commonly seen in the younger patients when compared to the older patients. These trends were more prominent in patients with surgical stage I disease. Age proved to be an independent risk factor influencing the accuracy of intraoperative staging using a logistic regression analysis. There was no difference in overall 3-year survival rate between the two age groups for each pathological TNM stage.

CONCLUSIONS

The present study showed that intra-operative under-staging was more common in young patients with gastric cancer, especially with stage I disease. This finding raises the concern for inaccurate diagnosis and surgical under treatment in younger patients with stage I gastric cancer.

Gastric cancer

Gastric cancer is one of the most common cancers and one of the most frequent causes of cancer-related deaths. The incidence, diagnostic studies, and therapeutic options have undergone important changes in the last decades, but the prognosis for gastric cancer patients remains poor, especially in more advanced stages. Surgery is the mainstay of treatment of this disease, even if it is associated with a high rate of locoregional and distant recurrence. There is ongoing debate regarding the role of adjuvant treatment In advanced disease, palliation of symptoms, rather than cure, is the primary goal of patient management. Several combination therapies have been developed and have been examined in phase III trials; however, in most cases, they have failed to demonstrate a survival advantage over the reference arm. This review summarizes the most important recommendations for the management of patients with gastric cancer.

Presentation and prognosis of gastric cancer in patients aged 80 years and older

The aim of this study was to analyze the characteristics of the presentation and prognosis of patients aged >/= 80 who were diagnosed with gastric adenocarcinoma. We have used a retrospective cohort study of 2334 patients diagnosed between 1975 and 1993 in northwestern Spain, 263 (11.3%)of whom were >/= 80 years of age. No differences were observed with respect to patients of a younger age at diagnosis regarding the site of the tumor, extension of the disease, or Laurén's histologic type. However, fewer resections with curative intent were performed in the older group (49.1% vs. 30.1%; p < 0.0001). Among those operated on with curative or palliative intent, at the end of the first month the survival probability was 0.9 and the 0.95% confidence interval (CI 95%) was 0.93-0.97 for patients < 80 years of age and 0.93 (CI 95% 0.89-0.98) for the older group ( p = 0.19). At the end of 5 years of follow-up these probabilities were 0.29 (CI 95% 0.27-0.31) and 0.18 (CI 95% 0.14-0.23), respectively ( p < 0.0001). If we consider only those patients undergoing curative resection, the survival probability for the two groups ( p = 0.4) was not statistically different. In conclusion, although the two groups showed similar characteristics at presentation, patients >/= 80 years of age underwent surgery with curative intent less frequently and their general prognosis was worse. Our data support the idea that curative surgery should not be ruled out exclusively for reasons of age.

Mortality for gastric cancer in elderly patients

BACKGROUND

The aim of this study was to clarify the surgical outcome in elderly patients with gastric cancer.

METHODS

The clinicopathological features of elderly patients (80 (3.7%), over 80 years, elderly group) were reviewed retrospectively and compared with those of younger patients (2095 (96.3%), 23-79 years, control group).

RESULTS

The elderly group had a significantly higher prevalence of concomitant disease (P < 0.0001), while the prevalence of T1 primary tumor, N0 lymph node metastasis, and stage I was lower (P = 0.0125, P = 0.0004, P < 0.0001). The rates of resected cases and curative operation (R0) were significantly lower in the elderly group (P < 0.0001, P = 0.0021). The mortality from other diseases was 16.3% in elderly patients and 4.4% in control patients (P < 0.0001). The 5-year survival of stage I and stage IV were not significantly different between the two groups (P = 0.1266 and P = 0.2490). The overall survival and disease-specific survival for all patients in the elderly group were significantly lower than those in the control group (P < 0.0001, P = 0.0102). However, disease-specific survival for resected cases was not significantly different between the two groups (P = 0.0725).

CONCLUSIONS

In elderly patients, the reason for the poor prognosis is the high rate of advanced stage and the high rate of death from other diseases.

Outcome of oesophagogastric carcinoma in young patients

The survival of young patients (< or = 50 years of age) with carcinoma of the oesophagus or stomach has been reported to be poorer than that of their older counterparts. The aim of the current study was to review the outcome of such young patients with oesophagogastric cancer and to compare the outcome in patients with carcinoma of the oesophagus/cardia with patients with carcinoma of the more distal stomach. The study population was 50 patients. Tumour location was oesophagus/cardia (n = 33) and gastric body/antrum (n = 17). The most common presenting symptoms were weight loss (66%), epigastric pain (54%), dysphagia (50%), and heartburn (40%). Seventeen patients had experienced foregut symptoms for a period of > or = 6 months. These patients were more likely to have symptoms of gastro-oesophageal reflux disease and to have received acid suppression therapy than patients with shorter symptom durations. Only 20 patients underwent a potentially curative resection, while 10 underwent open and close laparotomy. The overall median survival was 7 months and the 5-year survival was 8%. Multivariate analysis revealed that surgical resection and UICC stage were the only factors that significantly influenced survival. There was no difference in the survival of patients with proximally situated tumours compared to those with distally located tumours. Wide variations in clinical practice were seen between different surgeons. Consequently, a multidisciplinary team designed to manage all patients with oesophagogastric cancer according to nationally agreed protocols has been established in our hospital. Earlier diagnosis of these tumours is to be encouraged, even if this necessitates the more liberal use of endoscopy in the evaluation of young patients with persistent foregut symptoms.

The influence of age on the surgical management of carcinoma of the stomach

The medical records of 31,808 patients with gastric cancer registered with the West-Midlands Cancer Registry between 1957-1981 were reviewed to determine the influence of age on presentation, stage assessment, management, survival and mortality rates. When analysed by stage, and excluding post-operative deaths, survival was similar in all age groups. This study confirms stage of disease to be the single most important prognostic factor. The inverse relationship between laparotomy and age implies inadequate assessment of stage in the elderly. The poor prognosis in unresected cases suggests that increased precise staging by laparotomy or laparoscopy will have minimal adverse effects. On the other hand this may result in increased resections and survival.

Relationship between age and clinical characteristics of patients with gastric cancer

The relationship between the prognosis and age of patients with gastric cancer is controversial. To evaluate whether there is a biological characteristic specific to the age of patients, we examined the clinical characteristics of patients with gastric cancer with special reference to their age. Based on a prospective database, a retrospective study of 419 patients who underwent radical gastrectomy for cure in the past 6 years was conducted. Clinical characteristics including gender, gross appearance of the tumour (Borrmann's classification, tumour location), histopathology (depth of tumour invasion, lymph node status, Lauren's classification and degree of tumour cell differentiation) and TNM tumour stage were analysed in six different age groups (< 39, 40-49, 50-59, 60-69, 70-79, > 80 years). The mean age of the 419 patients was 64.6 years (range from 26-91) and the peak age incidence of gastric cancer (46.3%) was in the 60-69 year old age group. The male: female ratio was 4.6:1 on the whole and male gender predominated at ages > 60. The proportion of diffuse type tumours (68.4%) by Lauren's criteria in the young age group (< 39 yrs) decreased with age (25% in the > 80 years group; P < 0.001). Similarly, the proportion of poorly-differentiated tumours (89.5%) in the young age group (< 39 yrs) decreased with advancing age (P < 0.001). These findings suggest that both diffuse type and poorly-differentiated tumours predominate in younger patients and, without considering the factor of delay in diagnosis, may explain the poorer prognosis demonstrated in younger patients.