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Yu X, Tang W, Bai C, Li R, Feng B, Wu J, Guo X, Chen H, Li M. A predictive model for intraabdominal infection after radical gastrectomy in elderly patients. Medicine (Baltimore) 2024; 103:e37489. [PMID: 38489739 PMCID: PMC10939676 DOI: 10.1097/md.0000000000037489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 03/17/2024] Open
Abstract
Gastric cancer (GC) is one of the most common malignant tumors worldwide and the fourth leading cause of cancer-related deaths, with a relatively high incidence among the elderly population. Surgical resection is the mainstay treatment for GC and is currently the only cure. However, the incidence of postoperative intraabdominal infections remains high and seriously affects the prognosis. This study aimed to explore the risk factors for intraabdominal infections after radical gastrectomy in elderly patients and to establish and validate a risk prediction model. We collected the clinical data of 322 GC patients, who underwent radical gastrectomy at the General Surgery Department of China Medical University Dandong Central Hospital from January 2016 to January 2023. The patients were divided into an infected group (n = 27) and a noninfected group (n = 295) according to whether intraabdominal infections occurred postoperatively. A nomogram risk prediction model for the occurrence of postoperative intraabdominal infections was developed. All patients were randomized into a training set (n = 225) and a validation set (n = 97) in a 7:3 ratio, and the model was internally validated. Of the 322 patients, 27 (8.3%) experienced postoperative intraabdominal infections. Single-factor analysis revealed associations of intraabdominal infection with body mass index, glucose, hemoglobin, albumin, and other factors. The multifactorial analysis confirmed that body mass index, glucose, hemoglobin, albumin, surgical duration, and bleeding volume were independent risk factors for intraabdominal infections. The nomogram constructed based on these factors demonstrated excellent performance in both the training and validation sets. A nomogram model was developed and validated to predict the risk of intraabdominal infection after radical gastrectomy. The model has a good predictive performance, which could help clinicians prevent the occurrence of intraabdominal infections after radical gastrectomy in elderly patients.
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Affiliation(s)
- Xiaohan Yu
- General Surgery Department, Dandong Central Hospital, China Medical University, Dandong, Liaoning, China
| | - Wanyun Tang
- Orthopedics Department, Dandong Central Hospital, China Medical University, Dandong, Liaoning, China
| | - Chenglin Bai
- General Surgery Department, Dandong Central Hospital, Jinzhou Medical University, Dandong, Liaoning, China
| | - Runzhuo Li
- Gastroenterology Department, Dandong Central Hospital, China Medical University, Dandong, Liaoning, China
| | - Bo Feng
- General Surgery Department, Dandong Central Hospital, China Medical University, Dandong, Liaoning, China
| | - Jinge Wu
- General Surgery Department, Dandong Central Hospital, China Medical University, Dandong, Liaoning, China
| | - Xianzhan Guo
- General Surgery Department, Dandong Central Hospital, China Medical University, Dandong, Liaoning, China
| | - Hong Chen
- General Surgery Department, Dandong Central Hospital, China Medical University, Dandong, Liaoning, China
| | - Meng Li
- General Surgery Department, Dandong Central Hospital, China Medical University, Dandong, Liaoning, China
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Noguez-Ramos A, Gervaso L, Catanese S, Cella CA, Gandini S, Fazio N. Efficacy and safety of systemic chemotherapy for radically resectable esophago-gastric adenocarcinoma in older patients: A systematic review and meta-analysis. J Geriatr Oncol 2024; 15:101600. [PMID: 37550170 DOI: 10.1016/j.jgo.2023.101600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 06/17/2023] [Accepted: 07/31/2023] [Indexed: 08/09/2023]
Abstract
INTRODUCTION A significant proportion of locally-advanced esophago-gastric adenocarcinoma (EGA) is diagnosed in patients ≥70 years old (y.o.) who are commonly underrepresented in clinical trials. MATERIALS AND METHODS The PubMed database was searched for phase 2/3 clinical trials enrolling patients ≥70 y.o and reporting efficacy/safety information of chemotherapy for resectable EGA. The main outcomes were overall survival (OS) and recurrence-free survival (RFS). RESULTS Among 6,128 records, only seven studies reported these outcomes (three peri-operative, three adjuvant, and one neoadjuvant), including 1004 older patients, <20% of the overall population. No significant benefit in terms of OS and RFS was observed for perioperative or adjuvant chemotherapy vs surgery alone. No trial reported safety endpoints in this subgroup. DISCUSSION This work did not show any significant benefit in OS or RFS for chemotherapy vs surgery alone or conventional vs de-escalated chemotherapy in the curative setting of EGA in ≥70 y.o patients. Specific ad hoc trials should be performed to derive reliable data.
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Affiliation(s)
- Alejandro Noguez-Ramos
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IEO, IRCCS, Milan, Italy; Division of Medical Oncology, ABC Medical Center, Mexico City, Mexico
| | - Lorenzo Gervaso
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IEO, IRCCS, Milan, Italy; Molecular Medicine Department, University of Pavia, Pavia, Italy
| | - Silvia Catanese
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IEO, IRCCS, Milan, Italy
| | - Chiara Alessandra Cella
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IEO, IRCCS, Milan, Italy
| | - Sara Gandini
- Molecular and Pharmaco-Epidemiology Unit, European Institute of Oncology, IEO, IRCCS, Milan, Italy
| | - Nicola Fazio
- Division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors, European Institute of Oncology, IEO, IRCCS, Milan, Italy.
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Fujihata S, Sakuramoto S, Morimoto Y, Matsui K, Nishibeppu K, Ebara G, Fujita S, Oya S, Sugita H, Lee S, Miyawaki Y, Sato H, Takiguchi S, Yamashita K. Impact of loss of skeletal muscle mass within 6-12 months after gastrectomy and S1 adjuvant chemotherapy on the survival prognosis of elderly patients with gastric cancer. Surg Today 2022; 52:1472-1483. [PMID: 35394206 DOI: 10.1007/s00595-022-02489-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/16/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND PURPOSE We investigated the impact of postoperative changes in the psoas muscle mass index (PMI) after gastrectomy and S1 adjuvant chemotherapy (AC) on the long-term outcomes of elderly patients with gastric cancer. METHODS We reviewed the medical records of 228 patients aged over 75 years, who underwent distal, proximal, or total gastrectomy between January, 2013 and March 2017. Among these patients, 78 with pStage IIA-IIIC who survived for at least 1 year without recurrence after gastrectomy were the subjects of this analysis. RESULTS The log-rank test using the cut-off value from the rate of change in PMI from 6 to 12 months after gastrectomy (late rate of decrease) showed significantly poorer prognosis for the group above the cut-off value for both overall survival (OS) and recurrence-free survival (RFS) (RFS: PMI decrease ≥ 1.55%, p < 0.001; OS: PMI decrease ≥ 1.55%, p < 0.001). Patients with a relative dose intensity of S1 below 68.7% and a late rate of decrease in PMI above 1.55% were found to have a poor prognosis. CONCLUSION It is necessary to prevent decline in the PMI of elderly patients from 6 months after gastrectomy and to administer adjuvant chemotherapy with about two-thirds or more RDI of S1 to improve their survival prognosis.
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Affiliation(s)
- Shiro Fujihata
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka City, Saitama, 350-1298, Japan. shiro--
| | - Shinichi Sakuramoto
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka City, Saitama, 350-1298, Japan
| | - Yosuke Morimoto
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka City, Saitama, 350-1298, Japan
| | - Kazuaki Matsui
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka City, Saitama, 350-1298, Japan
| | - Keiji Nishibeppu
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka City, Saitama, 350-1298, Japan
| | - Gen Ebara
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka City, Saitama, 350-1298, Japan
| | - Shohei Fujita
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka City, Saitama, 350-1298, Japan
| | - Shuichiro Oya
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka City, Saitama, 350-1298, Japan
| | - Hirofumi Sugita
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka City, Saitama, 350-1298, Japan
| | - Seigi Lee
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka City, Saitama, 350-1298, Japan
| | - Yutaka Miyawaki
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka City, Saitama, 350-1298, Japan
| | - Hiroshi Sato
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka City, Saitama, 350-1298, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, 1 Kawasumi, Mizuho-ku, Nagoya, Aichi, Japan
| | - Keishi Yamashita
- Division of Advanced Surgical Oncology, Research and Development Center for New Medical Frontiers, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara City, Kanagawa, Japan
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Lee DU, Fan GH, Chang K, Lee KJ, Han J, Jung D, Kwon J, Karagozian R. The Clinical Impact of Advanced Age on the Postoperative Outcomes of Patients Undergoing Gastrectomy for Gastric Cancer: Analysis Across US Hospitals Between 2011–2017. J Gastric Cancer 2022; 22:197-209. [PMID: 35938366 PMCID: PMC9359884 DOI: 10.5230/jgc.2022.22.e18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/19/2022] [Accepted: 03/21/2022] [Indexed: 12/27/2022] Open
Abstract
Purpose This study systematically evaluated the implications of advanced age on post-surgical outcomes following gastrectomy for gastric cancer using a national database. Materials and Methods The 2011–2017 National Inpatient Sample was used to isolate patients who underwent gastrectomy for gastric cancer. From this, the population was stratified into those belonging to the younger age cohort (18–59 years), sexagenarians, septuagenarians, and octogenarians. The younger cohort and each advanced age category were compared in terms of the following endpoints: mortality following surgery, length of hospital stay, charges, and surgical complications. Results This study included a total of 5,213 patients: 1,366 sexagenarians, 1,490 septuagenarians, 743 octogenarians, and 1,614 under 60 years of age. Between the younger cohort and sexagenarians, there was no difference in mortality (2.27 vs. 1.67%; P=0.30; odds ratio [OR], 1.36; 95% confidence interval [CI], 0.81–2.30), length of stay (11.0 vs. 11.1 days; P=0.86), or charges ($123,557 vs. $124,425; P=0.79). Compared to the younger cohort, septuagenarians had higher rates of in-hospital mortality (4.30% vs. 1.67%; P<0.01; OR, 2.64; 95% CI, 1.67–4.16), length of stay (12.1 vs. 11.1 days; P<0.01), and charges ($139,200 vs. $124,425; P<0.01). In the multivariate analysis, septuagenarians had higher mortality (P=0.01; adjusted odds ratio [aOR], 2.01; 95% CI, 1.18–3.43). Similarly, compared to the younger cohort, octogenarians had a higher rate of mortality (7.67% vs. 1.67%; P<0.001; OR, 4.88; 95% CI, 3.06–7.79), length of stay (12.3 vs. 11.1 days; P<0.01), and charges ($131,330 vs. $124,425; P<0.01). In the multivariate analysis, octogenarians had higher mortality (P<0.001; aOR, 4.03; 95% CI, 2.28–7.11). Conclusions Advanced age (>70 years) is an independent risk factor for postoperative death in patients with gastric cancer undergoing gastrectomy.
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Affiliation(s)
- David Uihwan Lee
- Division of Gastroenterology and Hepatology, University of Maryland, Baltimore, MD, USA
| | - Gregory Hongyuan Fan
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - Kevin Chang
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - Ki Jung Lee
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - John Han
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - Daniel Jung
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - Jean Kwon
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - Raffi Karagozian
- Liver Center, Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
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Zhang Y, Yu C. Development and validation of a Surveillance, Epidemiology, and End Results (SEER)-based prognostic nomogram for predicting survival in elderly patients with gastric cancer after surgery. J Gastrointest Oncol 2021; 12:278-296. [PMID: 34012626 DOI: 10.21037/jgo-20-536] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Elderly gastric cancer (ELGC) remains one of the intensively investigated topics during the last decades. To establish a comprehensive nomogram for effective clinical practice and assessment is of significance. This study is designed to develop a prognostic nomogram for ELGC both in overall survival (OS) and cancer-specific survival (CSS). Methods The recruited cases were from the Surveillance, Epidemiology, and End Results (SEER) database and input for the construction of nomogram. Results A total of 4,414 individuals were recruited for this study, of which 2,208 were randomly in training group and 2,206 were in validation group. In univariate analysis of OS, significant variables (P<0.05) included age, marital status, grade, American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) stage, bone/brain/liver/lung metastasis and tumor size. In univariate analysis of CSS, significant variables (P<0.05) included age, grade, AJCC TNM stage, bone/brain/liver/lung metastasis and tumor size. In multivariate analysis of OS, sex, age, race, grade, TNM stage, lung metastasis and tumor size were considered as the significant variables and subjected to the establishment of nomogram. In multivariable analysis of CSS, age, grade, TNM, tumor size were considered as the significant variables and input to the establishment of nomogram. Sex, age, race, grade, TNM stage, lung metastasis and tumor size were included for the establishment of nomogram in OS while age, grade, TNM, tumor size were included to the establishment of nomogram in CSS. C-index, decision curve analysis (DCA) and the area under the curve (AUC) showed distinct value of newly established nomogram models. Both OS and CSS nomograms showed higher statistic power over the AJCC stage. Conclusions This study established and validated novel nomogram models of OS and CSS for ELGC based on population dataset.
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Affiliation(s)
- Yujie Zhang
- Department of Gastrointestinal Surgery, Tongji Hospital, Tongji Medical College in Huazhong University of Science and Technology, Wuhan, China
| | - Chaoran Yu
- Fudan University Shanghai Cancer Center, Fudan University, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
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Kuroki K, Oka S, Tanaka S, Yorita N, Hata K, Kotachi T, Boda T, Arihiro K, Shimamoto F, Chayama K. Preceding endoscopic submucosal dissection in submucosal invasive gastric cancer patients does not impact clinical outcomes. Sci Rep 2021; 11:990. [PMID: 33441652 PMCID: PMC7806757 DOI: 10.1038/s41598-020-79696-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 12/09/2020] [Indexed: 11/26/2022] Open
Abstract
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.
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Affiliation(s)
- Kazutaka Kuroki
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Kasumi 1-2-3 Minami-ku, Hiroshima-shi, Hiroshima, Japan
| | - Shiro Oka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Kasumi 1-2-3 Minami-ku, Hiroshima-shi, Hiroshima, Japan.
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Naoki Yorita
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Kasumi 1-2-3 Minami-ku, Hiroshima-shi, Hiroshima, Japan
| | - Kosaku Hata
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Kasumi 1-2-3 Minami-ku, Hiroshima-shi, Hiroshima, Japan
| | - Takahiro Kotachi
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Tomoyuki Boda
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Koji Arihiro
- Department of Anatomical Pathology, Hiroshima University Hospital, Hiroshima, Japan
| | - Fumio Shimamoto
- Department of Faculty of Human Culture and Sciences, Hiroshima Shudo University, Hiroshima, Japan
| | - Kazuaki Chayama
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Kasumi 1-2-3 Minami-ku, Hiroshima-shi, Hiroshima, Japan
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Modified Frailty Index is Useful in Predicting Non-home Discharge in Elderly Patients with Gastric Cancer Who Undergo Gastrectomy. World J Surg 2020; 44:3837-3844. [DOI: 10.1007/s00268-020-05691-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 12/21/2022]
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Guo J, Yu J, Xu Z, Sun X, Zheng J. The role of surgery in patients aged 85 years or older with resectable gastric cancer: a propensity score matching analysis of the SEER database. Scand J Gastroenterol 2020; 55:694-700. [PMID: 32459113 DOI: 10.1080/00365521.2020.1769175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- Jing Guo
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Junhui Yu
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhengshui Xu
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xuejun Sun
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jianbao Zheng
- Department of General Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Joharatnam-Hogan N, Shiu KK, Khan K. Challenges in the treatment of gastric cancer in the older patient. Cancer Treat Rev 2020; 85:101980. [PMID: 32065879 DOI: 10.1016/j.ctrv.2020.101980] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 12/24/2022]
Abstract
Gastric cancer is considered an age-related disease, with the majority of new cases in the UK diagnosed in individuals over the age of 75. At present most guidance related to the management of gastric cancer is based on trials undertaken in the fit, younger patient. Historically the elderly have been underrepresented in clinical trials, which frequently have a restricted inclusion to an upper age limit of 75. The European Society for Medical Oncology (ESMO) recommends use of a geriatric assessment to determine functional age when initiating treatment in elderly patients with gastric cancer, which has been shown to be a better predictor of treatment response than chronological age. The physiological changes that occur with age, including reduced organ function and pharmacokinetic and pharmacodynamic variability, together with impaired functional status, necessitate a more individualised approach to treatment decisions in the older patient to provide them with the same advantages from radical treatment and palliative chemotherapy as younger patients. This review summarises the current evidence extrapolated from trial data on how best to optimise treatment for elderly patients with gastric cancer.
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Affiliation(s)
- Nalinie Joharatnam-Hogan
- Gastrointestinal Oncology, Department of Medicine, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK
| | - Kai Keen Shiu
- Gastrointestinal Oncology, Department of Medicine, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK
| | - Khurum Khan
- Gastrointestinal Oncology, Department of Medicine, University College London NHS Foundation Trust, 250 Euston Road, London NW1 2PG, UK.
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Risk stratification for lymph node metastasis using Epstein-Barr virus status in submucosal invasive (pT1) gastric cancer without lymphovascular invasion: a multicenter observational study. Gastric Cancer 2019; 22:1176-1182. [PMID: 31062195 DOI: 10.1007/s10120-019-00963-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 04/03/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lymphovascular invasion (LVI) is a strong predictive factor for lymph node metastasis (LNM) in early gastric cancer (GC). This study investigated the risk for LNM in pT1b GC without LVI based on Epstein-Barr virus (EBV) status in addition to conventional clinicopathological parameters. METHODS In total, 847 consecutive patients of pT1b GC without LVI who underwent surgery at three high-volume centers between 2005 and 2014 were retrospectively analyzed. Clinicopathological parameters and EBV status were evaluated, and univariate and multivariate analyses were performed to estimate LNM risk. With regard to the presence of those three parameters, risk stratification for LNM was performed and compared with a previously proposed risk classification that included low-risk (LNM < 3.0%), intermediate-risk (LNM ≥ 3.0 and < 19.6%), and high-risk (LNM ≥ 19.6%) groups. RESULTS EBV-positive GC (EBVGC) accounted for 11.3% (96 of 847) of cases; LNM was lower in EBVGC than in non-EBVGC (1 of 96, 1.0% vs. 71/751, 9.5%). In the multivariate analysis, non-EBVGC [odds ratio (OR) 10.8, 95% confidence interval (CI) 1.48-78.9], age < 65 years (OR 2.13, 95% CI 1.30-3.48), and tumor diameter > 3 cm (OR 2.26, 95% CI 1.36-3.74) were independent risk factors for LNM. Patients with EBVGC were at low risk for LNM whereas those with all of three independent risk factors were at high risk (36 of 168, 21.4%, 95% CI 15.5-28.4). CONCLUSION LNM risk stratification that includes EBV status is useful for clinical decision-making in pT1b GC cases without LVI.
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Maezawa Y, Aoyama T, Kano K, Tamagawa H, Numata M, Hara K, Murakawa M, Yamada T, Sato T, Ogata T, Oshima T, Yukawa N, Yoshikawa T, Masuda M, Rino Y. Impact of the Age-adjusted Charlson comorbidity index on the short- and long-term outcomes of patients undergoing curative gastrectomy for gastric cancer. J Cancer 2019; 10:5527-5535. [PMID: 31632496 PMCID: PMC6775689 DOI: 10.7150/jca.35465] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/06/2019] [Indexed: 12/17/2022] Open
Abstract
Background: The aim of this study was to determine whether or not the short- and long-term outcomes were affected by the age-adjusted Charlson comorbidity index (ACCI) in patients who underwent curative resection for gastric cancer. Methods: The patients were retrospectively selected from among the medical records of consecutive patients who underwent curative gastrectomy with nodal dissection for gastric cancer at Yokohama City University and Kanagawa Cancer Center from January 2000 to August 2015. Results: A total of 2254 patients were eligible for inclusion in the present study. One thousand six hundred fifty-six patients had an ACCI of <6 points (ACCI low group), while 598 had a score of ≥6 points (ACCI high group). The median age (p<0.001) and American Society of Anesthesiologists physical status (ASA-PS) score (p<0.001) of the ACCI high group were higher in comparison to the ACCI low group. The incidence of surgical complications in the ACCI high group was significantly higher than that in the ACCI low group (12.0% vs. 7.2%, p<0.001). Univariate and multivariate analyses demonstrated that an ACCI high classification was a significant risk factor for postoperative complications. In addition, the 5-year OS rates of the ACCI low and ACCI high groups were 85.4% and 74.1%, respectively. The difference was statistically significant (p<0.001). The univariate and multivariate analyses demonstrated that an ACCI high classification was a significant prognostic factor for OS. Conclusions: Our results support that a high ACCI value is an independent risk factor for the short- and long-term outcomes of patients with gastric cancer. To improve the survival of patients with gastric cancer, it is necessary to carefully plan the perioperative care and the surgical strategy according to the ACCI.
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Affiliation(s)
- Yukio Maezawa
- Department of Surgery, Yokohama City University, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.,Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-ku, Yokohama, Kanagawa 241-8515, Japan
| | - Toru Aoyama
- Department of Surgery, Yokohama City University, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Kazuki Kano
- Department of Surgery, Yokohama City University, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Hiroshi Tamagawa
- Department of Surgery, Yokohama City University, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Masakatsu Numata
- Department of Surgery, Yokohama City University, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Kentaro Hara
- Department of Surgery, Yokohama City University, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Masaaki Murakawa
- Department of Surgery, Yokohama City University, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.,Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-ku, Yokohama, Kanagawa 241-8515, Japan
| | - Takanobu Yamada
- Department of Surgery, Yokohama City University, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.,Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-ku, Yokohama, Kanagawa 241-8515, Japan
| | - Tsutomu Sato
- Department of Surgery, Yokohama City University, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Takashi Ogata
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-ku, Yokohama, Kanagawa 241-8515, Japan
| | - Takashi Oshima
- Department of Surgery, Yokohama City University, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.,Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-ku, Yokohama, Kanagawa 241-8515, Japan
| | - Norio Yukawa
- Department of Surgery, Yokohama City University, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Takaki Yoshikawa
- Department of Surgery, Yokohama City University, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan.,Department of Gastrointestinal Surgery, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-ku, Yokohama, Kanagawa 241-8515, Japan.,Department of Gastric Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-Ku, Tokyo 104-0045, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University, 3-9, Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan
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12
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Fanotto V, Fornaro L, Bordonaro R, Rosati G, Rimassa L, Di Donato S, Santini D, Tomasello G, Leone F, Silvestris N, Stragliotto S, Scartozzi M, Giampieri R, Nichetti F, Antonuzzo L, Cinieri S, Avallone A, Pellegrino A, Melisi D, Vasile E, Gerratana L, Aprile G. Second-line treatment efficacy and toxicity in older vs. non-older patients with advanced gastric cancer: A multicentre real-world study. J Geriatr Oncol 2018; 10:591-597. [PMID: 30551958 DOI: 10.1016/j.jgo.2018.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/04/2018] [Accepted: 11/28/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Although gastric cancer (GC) incidence rises with age, older patients are poorly represented in clinical trials, whose results are therefore difficult to translate into standard management of older patients. Purpose of this study was to compare clinico-pathological features and survival outcomes between older and non-older patients with advanced GC treated with at least two chemotherapy lines. MATERIALS AND METHODS Clinico-pathological characteristics, basal values, and treatment data of older (≥70 years at second-line start) and non-older patients were compared using chi-square test or 2-tailed Fisher exact test. The Kaplan-Meier estimation was used to calculate progression-free survival (PFS) and overall survival (OS), which were examined by log-rank test. RESULTS Older patients represented 31.8% of the population (N = 868). Intestinal type was more frequent in older patients (P = .02). Poorly differentiated tumours were more often observed in non-older patients (P = .009). At stage IV diagnosis, the rate of liver metastases was higher in older patients (P = .02), while peritoneal spread was more represented in non-older patients (P = .002). Although older patients were more often treated with monotherapy (P = .001), they had similar PFS (HR 0.86, 95%CI 0.71-1.03, P = .102) and OS (HR 0.82, 95%CI 0.65-1.02, P = .08) compared to the non-older counterpart. No statistical differences were observed in treatment-related adverse events, hospital admissions, or further treatment lines between age groups. CONCLUSION In our large cohort study, despite some differences in tumour characteristics and treatment intensity, no survival difference was found between older and non-older patients with advanced GC treated with at least two chemotherapy lines. Incidence of adverse events was similar between age groups.
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Affiliation(s)
- Valentina Fanotto
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Lorenzo Fornaro
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | | | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, Rozzano(MI), Italy
| | | | | | | | - Francesco Leone
- Medical Oncology, University of Turin, Candiolo Cancer Institute, FPO, IRCCS, Turin, Italy
| | - Nicola Silvestris
- Medical Oncology Unit, National Cancer Institute IRCCS "Giovanni Paolo II", Bari, Italy
| | - Silvia Stragliotto
- UOC Oncologia Medica 1, Dip. di Oncologia, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Mario Scartozzi
- Medical Oncology, University of Cagliari, University Hospital, Cagliari, Italy
| | | | - Federico Nichetti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | - Antonio Avallone
- Experimental Abdomen Medical Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italy
| | | | | | - Enrico Vasile
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Lorenzo Gerratana
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Giuseppe Aprile
- Department of Oncology, University and General Hospital, Udine, Italy; Department of Oncology, San Bortolo General Hospital, ULSS8 Berica - East District, Vicenza, Italy.
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13
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Liu L, Lu DY, Cai JR, Zhang L. The value of oral contrast ultrasonography in the diagnosis of gastric cancer in elderly patients. World J Surg Oncol 2018; 16:233. [PMID: 30526671 PMCID: PMC6286526 DOI: 10.1186/s12957-018-1527-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 11/12/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study aims to investigate the value of oral contrast ultrasonography (OCUS) in the diagnosis of gastric cancer in elderly patients. METHODS OCUS data obtained from patients ≥ 60 years old were retrospectively analyzed and compared with gastroscopy results. RESULTS Among the 12,716 subjects examined by OCUS, 5021 subjects were ≥ 60 years old, which accounted for 39.48% (5021/12,716). Gastritis, gastric polyp, benign ulcer, and gastric cancer were detected by OCUS in 1099 patients. Among them, 196 patients underwent gastroscopy. Furthermore, ulcerative lesions were detected in 32 patients by OCUS and in 51 patients by gastroscopy, and the coincidence rate was 62.74%. Among these patients, gastric cancer was diagnosed in 18 patients by OCUS with a detection rate of 1.64% (18/1099) and detected in 19 patients by gastroscopy with a diagnostic coincidence rate of 94.73% (18/19). Furthermore, benign ulcer was detected in 14 patients by OCUS and in 32 patients by gastroscopy, and the diagnostic coincidence rate was 43.75% (14/32). CONCLUSION OCUS helps to timely detect senile gastric cancer and can be used as a suitable technique for the detection of gastric diseases.
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Affiliation(s)
- Lan Liu
- Department of Ultrasonography, Chongming branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 25 South Gate Road, Cheng Qiao Town, Chongming District, Shanghai, 202150 China
| | - Dian-Yuan Lu
- Department of Ultrasonography, Chongming branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 25 South Gate Road, Cheng Qiao Town, Chongming District, Shanghai, 202150 China
| | - Jian-Rong Cai
- Department of Ultrasonography, Chongming branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 25 South Gate Road, Cheng Qiao Town, Chongming District, Shanghai, 202150 China
| | - Li Zhang
- Department of Ultrasonography, Chongming branch of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 25 South Gate Road, Cheng Qiao Town, Chongming District, Shanghai, 202150 China
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14
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Pak LM, Yang T, Wang J. The safety and efficacy of gastrectomy for gastric cancer among octogenarians: a western population-based study. J Geriatr Oncol 2018; 10:598-603. [PMID: 30366851 DOI: 10.1016/j.jgo.2018.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/06/2018] [Accepted: 10/17/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The safety of minimally-invasive (MIG) and open gastrectomy (OG) in the older patients has been demonstrated in several international studies but has not been evaluated in the context of a large, Western population. The objective of this study was to evaluate the safety of gastrectomy by these two approaches among octogenarians in the United States. MATERIALS AND METHODS The National Cancer Database (2010-2014) was queried for patients with gastric adenocarcinoma who underwent MIG or OG. Disease and treatment characteristics and outcomes were compared across age groups (<65, 65-79, ≥80 years). Multivariable regression analysis was used to identify factors associated with 90-day mortality. RESULTS 13,845 patients were identified who met study inclusion criteria, of which 2140 patients (16%) were aged ≥80 years. Among octogenarians, MIG was associated with slightly decreased length of stay (11.2 vs 12.7 days, p < .001) compared to OG, with no difference in the rate of margin-positive resections, adequate lymph node sampling, or readmission (p = .30-0.77). 90-day mortality for both OG (17%) and MIG (17.2%) was significantly higher among octogenarians compared to younger patients (p < .001). Treatment at an academic facility was an independent predictor of decreased 90-day mortality among octogenarians (OR 0.534, 95%CI 0.322-0.886, p = .015). CONCLUSION In this Western population, we report comparable oncologic and post-operative outcomes between MIG and OG. However, the overall post-operative mortality rate among octogenarians remains unacceptably high. Better patient selection criteria for surgery and efforts to refer these patients to higher volume, academic facilities should be considered to improve patient outcomes.
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Affiliation(s)
- Linda M Pak
- Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
| | - Tingsong Yang
- Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Jiping Wang
- Division of Surgical Oncology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
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15
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Surgical treatment outcomes of patients with T1-T2 gastric cancer: does the age matter when excellent treatment results are expected? World J Surg Oncol 2018; 16:79. [PMID: 29661204 PMCID: PMC5902993 DOI: 10.1186/s12957-018-1388-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/10/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The proportion of early gastric cancer stages is increasing, as is the incidence of gastric cancer among the elderly population. Therefore, this study was designed to analyze surgical treatment outcomes of T1-T2 gastric cancer in elderly patients. METHODS A total of 457 patients with T1-T2 gastric cancer who underwent gastrectomy between 2005 and 2015 were enrolled in this retrospective study. Patients were classified into two groups according to age (< 70 years versus ≥ 70 years). Clinicopathological features, surgical treatment results, and clinical outcomes were compared between the groups. RESULTS Higher ASA score (ASA 3/4), differentiated cancer, and intestinal-type tumors were more common in elderly patients. Postoperative complication rates were similar between the two groups; however, postoperative mortality rates were significantly higher in the elderly group. Higher ASA score was independently associated with postoperative complications in the elderly group. Furthermore, severe postoperative complications were found as an independent factor associated with higher 90-day mortality rate. Elderly patients had a significantly poorer 5-year overall survival rate. Two surgery-related factors-total gastrectomy and complicated postoperative course-were revealed as independent prognostic factors for poor overall survival in the elderly group. CONCLUSIONS Despite higher postoperative mortality rate and poorer overall survival results, elderly patients with gastric cancer should be considered for radical surgery. ASA score may be useful for predicting surgical treatment outcomes in elderly patients undergoing surgery for GC and hence assists clinicians in planning treatment strategies for each individual patient.
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16
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Saito H, Kono Y, Murakami Y, Shishido Y, Kuroda H, Matsunaga T, Fukumoto Y, Osaki T, Ashida K, Fujiwara Y. Postoperative Serum Albumin is a Potential Prognostic Factor for Older Patients with Gastric Cancer. Yonago Acta Med 2018. [PMID: 29599625 DOI: 10.33160/yam.2018.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background The incidence of gastric cancer (GC) among older adults is increasing. Therefore, determining postoperative age-associated prognostic factors is clinically important. This study retrospectively investigated the prognostic significance of serum albumin level in older GC patients. Methods We enrolled 135 patients aged ≥ 75 years, who underwent gastrectomies with histopathological diagnoses of gastric adenocarcinoma. Results Preoperative albumin (pre-Alb) levels in patients with advanced GC and stage III/IV GC were significantly lower than those in patients with early GC (P = 0.0032) and stage I/II GC (P = 0.006), respectively. Postoperative albumin (post-Alb) levels (measured 1 month after surgery) in male patients and in patients with advanced GC were significantly lower than those in female patients (P = 0.024) and those with early GC (P = 0.044), respectively. Post-Alb levels of patients who died of other diseases were significantly lower than those who were still living (P = 0.0004). Prognosis of patients with high post-Alb levels (≥ 4g/dL) was significantly better than that of patients with low post-Alb levels (< 4g/dL; P = 0.045); and in multivariate analysis, post-Alb level was an independent prognostic indicator. Conclusion Post-Alb level is a useful predictive factor for the prognosis of older GC patients. Postoperative nutritional support might help improve the prognosis of older GC patients.
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Affiliation(s)
- Hiroaki Saito
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Yusuke Kono
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Yuki Murakami
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Yuji Shishido
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Hirohiko Kuroda
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Tomoyuki Matsunaga
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Yoji Fukumoto
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Tomohiro Osaki
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Keigo Ashida
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
| | - Yoshiyuki Fujiwara
- Division of Surgical Oncology, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago 683-8504, Japan
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17
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Visa L, Jiménez-Fonseca P, Martínez EA, Hernández R, Custodio A, Garrido M, Viudez A, Buxo E, Echavarria I, Cano JM, Macias I, Mangas M, de Castro EM, García T, Manceñido FÁ, Montes AF, Azkarate A, Longo F, Serrano AD, López C, Hurtado A, Cerdá P, Serrano R, Gil-Negrete A, Carnicero AM, Pimentel P, Ramchandani A, Carmona-Bayonas A. Efficacy and safety of chemotherapy in older versus non-older patients with advanced gastric cancer: A real-world data, non-inferiority analysis. J Geriatr Oncol 2017; 9:254-264. [PMID: 29242093 DOI: 10.1016/j.jgo.2017.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/05/2017] [Accepted: 11/22/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Advanced gastric cancer (AGC) is a common neoplasm in older adults. Nevertheless, there are few specific management data in the literature. The aim of this study was to assess non-inferiority of survival and efficacy-related outcomes of chemotherapy used in older vs non-older patients with AGC. MATERIALS AND METHODS We recruited 1485 patients from the AGAMENON registry of AGC treated with polychemotherapy between 2008-2017. A statistical analysis was conducted to prove non-inferiority for overall survival (OS) associated with the use of chemotherapy schedules in individuals ≥70 vs.<70years. The fixed-margin method was used (hazard ratio [HR]<1.176) that corresponds to conserving at least 85% efficacy. RESULTS 33% (n=489) of the cases analyzed were ≥70 years. Two-agent chemotherapies and combinations with oxaliplatin (48% vs. 29%) were used more often in the older patients, as were modified schedules and/or lower doses. Toxicity grade 3-4 was comparable in both groups, although when looking at any grade, there were more episodes of enteritis, renal toxicity, and fatigue in older patients. In addition, toxicity was a frequent cause for discontinuing treatment in older patients. The response rate was similar in both groups. After adjusting for confounding factors, the non-inferiority of OS associated with schedules administered to the older vs. younger subjects was confirmed: HR 1.02 (90% CI, 0.91-1.14), P (non inferiority)=0.018, as well as progression-free survival: HR 0.97 (90% CI, 0.87-1.08), P(non-inferiority)=0.001. CONCLUSION In this AGC registry, the use of chemotherapy with schedules adapted to patients ≥70 years provided efficacy that was not inferior to that seen in younger cases, with comparable adverse effects.
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Affiliation(s)
- Laura Visa
- Medical Oncology Department, Hospital del Mar, Barcelona, Spain.
| | - Paula Jiménez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Raquel Hernández
- Medical Oncology Department, Hospital Universitario de Canarias, Tenerife
| | - Ana Custodio
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, CIBERONC CB16/12/00398, Spain
| | - Manuel Garrido
- Medical Oncology Department, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Antonio Viudez
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Elvira Buxo
- Medical Oncology Department, Hospital Universitari Clinic, Barcelona, Spain
| | - Ignacio Echavarria
- Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Juana María Cano
- Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain
| | - Ismael Macias
- Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain
| | - Montserrat Mangas
- Medical Oncology Department, Hospital Galdakao-Usansolo, Galdakao-Usansolo, Spain
| | - Eva Martínez de Castro
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Teresa García
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - Felipe Álvarez Manceñido
- Medical Oncology Department, Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Aitor Azkarate
- Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain
| | - Federico Longo
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Carlos López
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Alicia Hurtado
- Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Paula Cerdá
- Medical Oncology Department, Centro Médico Teknon, Barcelona, Spain
| | - Raquel Serrano
- Medical Oncology Department, Hospital Universitario Virgen de las Nieves, Córdoba, Spain
| | - Aitziber Gil-Negrete
- Medical Oncology Department, Hospital Universitario Donostia, San Sebastián, Spain
| | - Alfonso Martín Carnicero
- Medical Oncology Department, Complejo Hospitalario San Millán-San Pedro de La Rioja, Logroño, Spain
| | - Paola Pimentel
- Medical Oncology Department, Hospital Santa Lucía, Cartagena, Spain
| | - Avinash Ramchandani
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain
| | - Alberto Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
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18
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Clinical impact of small advanced gastric cancer (≤ 40 mm) in elderly patients: A retrospective cohort study. Int J Surg 2017; 45:131-137. [DOI: 10.1016/j.ijsu.2017.07.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/06/2017] [Accepted: 07/14/2017] [Indexed: 01/07/2023]
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19
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Zhou K, Wen F, Zhang P, Zhou J, Chen H, Zheng H, Yang Y, Li Q. Efficacy and cost-effectiveness of second-line chemotherapy in elderly patients with advanced gastric cancer. Clin Transl Oncol 2017; 19:1117-1124. [DOI: 10.1007/s12094-017-1647-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 03/13/2017] [Indexed: 01/13/2023]
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20
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Yoshikawa K, Shimada M, Higashijima J, Nakao T, Nishi M, Kashihara H, Takasu C. Limited lymph node dissection in elderly patients with gastric cancer. THE JOURNAL OF MEDICAL INVESTIGATION 2017; 63:91-5. [PMID: 27040060 DOI: 10.2152/jmi.63.91] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND The number of elderly patients with gastric cancer is continuing to increase along with the life expectancy of the general population. The purpose of this study was to investigate both the impact of age on postoperative outcome and the effect of limited lymph node dissection for elderly patients. METHODS Patients were classified into the following three groups: Group A, ≥80 years old (n=44); Group B, 70-80 years old (n=139); Group C, <70 years old (n=219). Postoperative complication and survival rates were compared between the three groups Results: Limited lymph node dissection was performed significantly more frequently in Group A. In terms of surgery-related complications, no significant difference was seen between groups. In terms of general related complications, the complication rate increased with age, from 4% in Group C to 13% in Group B and 14% in Group A (p<0.05 each). Although limited lymph node dissection was frequently performed in Group A, cancer-specific survival showed no significant difference in R0 patients. CONCLUSIONS Limited lymph node dissection for gastric cancer did not affect the cancer-specific survival in elderly patients.
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Ruspi L, Galli F, Pappalardo V, Inversini D, Martignoni F, Boni L, Dionigi G, Rausei S. Lymphadenectomy in elderly/high risk patients: should it be different? Transl Gastroenterol Hepatol 2017; 2:5. [PMID: 28217755 DOI: 10.21037/tgh.2016.12.07] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 12/27/2016] [Indexed: 12/26/2022] Open
Abstract
The global aging of population will lead a greater number of elderly patients to undergo surgical procedure in a near future. Concerning gastric cancer, the impact of lymphadenectomy on survival has been demonstrated in RCTs, and extended lymphadenectomy is now considered as gold standard of treatment in non-early tumors. However, the role of age as a prognostic factor and the benefit of extended surgery in elderly/high-risk patients are not clearly defined yet. From our revision of literature, it seems that surgery for gastric cancer may have a further tailorization, considering not only the stage of disease, but also patients' age and comorbidities.
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Affiliation(s)
- Laura Ruspi
- Department of General Surgery, University of Insubria, 21100 Varese, Italy; Department of Surgical Sciences, University of Insubria, 21100 Varese, Italy
| | - Federica Galli
- Department of General Surgery, University of Insubria, 21100 Varese, Italy; Department of Surgical Sciences, University of Insubria, 21100 Varese, Italy
| | - Vincenzo Pappalardo
- Department of General Surgery, University of Insubria, 21100 Varese, Italy; Department of Surgical Sciences, University of Insubria, 21100 Varese, Italy
| | - Davide Inversini
- Department of General Surgery, University of Insubria, 21100 Varese, Italy; Department of Surgical Sciences, University of Insubria, 21100 Varese, Italy
| | - Francesco Martignoni
- Department of General Surgery, University of Insubria, 21100 Varese, Italy; Department of Surgical Sciences, University of Insubria, 21100 Varese, Italy
| | - Luigi Boni
- Department of General Surgery, University of Insubria, 21100 Varese, Italy; Department of Surgical Sciences, University of Insubria, 21100 Varese, Italy
| | - Gianlorenzo Dionigi
- Department of General Surgery, University of Insubria, 21100 Varese, Italy; Department of Surgical Sciences, University of Insubria, 21100 Varese, Italy
| | - Stefano Rausei
- Department of General Surgery, University of Insubria, 21100 Varese, Italy; Department of Surgical Sciences, University of Insubria, 21100 Varese, Italy
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Clinical Characteristics and Outcomes of Gastric Cancer Patients Aged over 80 Years: A Retrospective Case-Control Study. PLoS One 2016; 11:e0167615. [PMID: 27942044 PMCID: PMC5152853 DOI: 10.1371/journal.pone.0167615] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 11/17/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND AIMS The average human life expectancy is increasing worldwide, thus the proportion of elderly gastric cancer patients is also increasing. In this case-control study, we investigated the clinical and oncologic outcomes of gastric cancer in patients over 80 years old. METHODS From January 2004 to December 2010, 291 patients aged over 80 years old (case group) were diagnosed and treated with gastric cancer at Asan Medical Center, Seoul, Korea. From the same period, 291 patients aged 18 to 80 years old were selected as the control group. The clinical findings and clinical outcomes of gastric cancer were retrospectively reviewed and compared between the two groups. RESULTS There were significant differences in the overall 5-year survival rate between the case and control groups (30.9% vs. 73.8%, respectively; P<0.001). In patients who received the curative treatment, overall 3- and 5-year survival rates showed 74.3% and 57.9% in case group and 91.6% and 86.5% in the control group. When analysis was confined to resectable elderly patients with a favorable performance, the curative resection group showed significantly better overall 3- and 5-year survival rates than the conservative treatment group (73.7% and 58.8% vs. 29.8% and 0%, respectively). CONCLUSIONS Although elderly gastric cancer patients show an advanced stage at diagnosis and poor prognosis compared with non-elderly patients, elderly patients with good performance could benefit from curative resection. Thus, the clinical decision whether to undergo curative resection or conservative management should be made on an individualized basis.
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Chang SH, Kim SN, Choi HJ, Park M, Kim RB, Go SI, Lee WS. Adjuvant Chemotherapy for Advanced Gastric Cancer in Elderly and Non-elderly Patients: Meta-Analysis of Randomized Controlled Trials. Cancer Res Treat 2016; 49:263-273. [PMID: 27384158 PMCID: PMC5266393 DOI: 10.4143/crt.2016.054] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 05/27/2016] [Indexed: 02/07/2023] Open
Abstract
PURPOSE This study evaluated the benefits of adjuvant chemotherapy on elderly patients with advanced gastric cancer (AGC) using meta-analysis of well-designed randomized controlled clinical studies. MATERIALS AND METHODS PubMed, Embase, and Cochrane were searched to retrieve clinical studies evaluating the benefits of adjuvant chemotherapy in the elderly with AGC. Hazards ratios (HRs) with 95% confidence intervals (CIs) were pooled across studies using a fixed-effects model. RESULTS Two studies were included in this meta-analysis to estimate HR for the overall survival (OS), and relapse-free survival (RFS) between adjuvant chemotherapy and surgery in elderly and non-elderly patients. HR for OS in the elderly and non-elderly was 0.745 (95% CI, 0.552 to 1.006, p=0.055) and 0.636 (95% CI, 0.522 to 0.776; p < 0.001), respectively, which showed no heterogeneity regarding HR between the two groups (pinteraction=0.389). HR for RFS in the elderly and non-elderly was 0.613 (95% CI, 0.466 to 0.806; p < 0.001) and 0.633 (95% CI, 0.533 to 0.753; p < 0.001), respectively (pinteraction=0.846). CONCLUSION Meta-analysis suggests that the benefit of adjuvant chemotherapy to the elderly is not big enough to reach statistical significance while the HR for OS is less than 1 (0.745) and no heterogeneity are observed regarding the HR between the elderly and non-elderly patients.
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Affiliation(s)
- Seong-Hwan Chang
- Department of Surgery, Konkuk University School of Medicine, Seoul, Korea
| | - Soo-Nyung Kim
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul, Korea
| | - Hye Jung Choi
- Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Misuk Park
- Medical Library, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Rock Bum Kim
- Department of Preventive Medicine and Environmental Health, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Se-Il Go
- Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Won Sup Lee
- Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
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Sohn IW, Jung DH, Kim JH, Chung HS, Park JC, Shin SK, Lee SK, Lee YC. Analysis of the Clinicopathological Characteristics of Gastric Cancer in Extremely Old Patients. Cancer Res Treat 2016; 49:204-212. [PMID: 27384160 PMCID: PMC5266408 DOI: 10.4143/crt.2016.163] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/07/2016] [Indexed: 12/19/2022] Open
Abstract
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.
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Affiliation(s)
- Il Woong Sohn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Da Hyun Jung
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jie-Hyun Kim
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Soo Chung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jun Chul Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Kwan Shin
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Kil Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Chan Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
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Rausei S, Ruspi L, Rosa F, Morgagni P, Marrelli D, Cossu A, Cananzi FCM, Lomonaco R, Coniglio A, Biondi A, Cipollari C, Graziosi L, Fumagalli U, Casella F, Bertoli P, di Leo A, Alfieri S, Vittimberga G, Roviello F, Orsenigo E, Quagliuolo V, Montemurro S, Baiocchi G, Persiani R, Bencivenga M, Donini A, Rosati R, Sansonetti A, Ansaloni L, Zanoni A, Galli F, Dionigi G. Extended lymphadenectomy in elderly and/or highly co-morbid gastric cancer patients: A retrospective multicenter study. Eur J Surg Oncol 2016; 42:1881-1889. [PMID: 27266816 DOI: 10.1016/j.ejso.2016.05.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 03/15/2016] [Accepted: 05/05/2016] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Gastrectomy with extended lymphadenectomy is considered the gold standard treatment for advanced gastric cancer, with no age- or comorbidity-related limitations. We evaluated the safety and efficacy of curative gastrectomy with extended nodal dissection, verifying survival in elderly and highly co-morbid patients. METHODS In a retrospective multicenter study, we examined 1322 non-metastatic gastric-cancer patients that underwent curative gastrectomy with D2 versus D1 lymphadenectomy from January 2000 to December 2009. Postoperative complications, overall survival (OS), and disease-specific survival (DSS) according to age and the Charlson Comorbidity Score were analyzed in relation to the extent of lymphadenectomy. RESULTS Postoperative morbidity was 30.4%. Complications were more frequent in highly co-morbid elderly patients, and, although general morbidity rates after D2 and D1 lymphadenectomy were similar (29.9% and 33.2%, respectively), they increased following D2 in highly co-morbid elderly patients (39.6%). D2-lymphadenectomy significantly improved 5-year OS and DSS (48.0% vs. 37.6% in D1, p < 0.001 and 72.6% vs. 58.1% in D1, p < 0.001, respectively) in all patients. In elderly patients, this benefit was present only in 5-year DSS. D2 nodal dissection induced better 5-year OS and DSS rates in elderly patients with positive nodes (29.7% vs. 21.2% in D1, p = 0.008 and 47.5% vs. 30.6% in D1, p = 0.001, respectively), although it was present only in DSS when highly co-morbid elderly patients were considered. CONCLUSION Extended lymphadenectomy confirmed better survival rates in gastric cancer patients. Due to high postoperative complication rate and no significant improvement of the OS, D1 lymphadenectomy should be considered in elderly and/or highly co-morbid gastric cancer patients.
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Affiliation(s)
- S Rausei
- Department of Surgery, University of Insubria, Viale Luigi Borri, 57, 21100 Varese, VA, Italy.
| | - L Ruspi
- Department of Surgery, University of Insubria, Viale Luigi Borri, 57, 21100 Varese, VA, Italy
| | - F Rosa
- Division of Digestive Surgery, Department of Surgical Sciences, Catholic University, Largo F. Vito, 1, 00168 Rome, RM, Italy
| | - P Morgagni
- General Surgery, Morgagni-Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, FC, Italy
| | - D Marrelli
- Department of General Surgery and Oncology, University of Siena, Policlinico Santa Maria alle Scotte, Viale Bracci, 53100 Siena, SI, Italy
| | - A Cossu
- Department of Surgery, Vita-Salute San Raffaele University, Via Olgettina, 58, 20132 Milan, MI, Italy
| | - F C M Cananzi
- Division of Surgical Oncology, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089 Rozzano, MI, Italy
| | - R Lomonaco
- Surgery Unit, National Cancer Research Centre, Giovanni Paolo II, Viale Orazio Flacco 65, 70124 Bari, BA, Italy
| | - A Coniglio
- Department of Clinical and Experimental Sciences, Brescia University, Piazzale Spedali Civili, 1, 25123 Brescia, BS, Italy
| | - A Biondi
- Division of General Surgery, Department of Surgical Sciences, Catholic University, Largo F. Vito, 1, 00168 Rome, RM, Italy
| | - C Cipollari
- Department of Surgery, University of Verona, Ospedale Borgo Trento, P.le A. Stefani 1, 37126 Verona, VR, Italy
| | - L Graziosi
- General and Emergency Surgery, University of Perugia, S. Andrea delle Fratte, 06156 Perugia, PG, Italy
| | - U Fumagalli
- Division of General and Minimally Invasive Surgery, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089 Rozzano, MI, Italy
| | - F Casella
- Division of General Surgery, Vannini Hospital, Via di Acqua Bullicante, 4, 00177 Rome, RM, Italy
| | - P Bertoli
- Division of General Surgery I, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, BG, Italy
| | - A di Leo
- Division of General Surgery, Rovereto Hospital, Corso Verona, 4, 38068 Rovereto, TN, Italy
| | - S Alfieri
- Division of Digestive Surgery, Department of Surgical Sciences, Catholic University, Largo F. Vito, 1, 00168 Rome, RM, Italy
| | - G Vittimberga
- General Surgery, Morgagni-Pierantoni Hospital, Via Carlo Forlanini, 34, 47121 Forlì, FC, Italy
| | - F Roviello
- Department of General Surgery and Oncology, University of Siena, Policlinico Santa Maria alle Scotte, Viale Bracci, 53100 Siena, SI, Italy
| | - E Orsenigo
- Department of Surgery, Vita-Salute San Raffaele University, Via Olgettina, 58, 20132 Milan, MI, Italy
| | - V Quagliuolo
- Division of Surgical Oncology, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089 Rozzano, MI, Italy
| | - S Montemurro
- Surgery Unit, National Cancer Research Centre, Giovanni Paolo II, Viale Orazio Flacco 65, 70124 Bari, BA, Italy
| | - G Baiocchi
- Department of Clinical and Experimental Sciences, Brescia University, Piazzale Spedali Civili, 1, 25123 Brescia, BS, Italy
| | - R Persiani
- Division of General Surgery, Department of Surgical Sciences, Catholic University, Largo F. Vito, 1, 00168 Rome, RM, Italy
| | - M Bencivenga
- Department of Surgery, University of Verona, Ospedale Borgo Trento, P.le A. Stefani 1, 37126 Verona, VR, Italy
| | - A Donini
- General and Emergency Surgery, University of Perugia, S. Andrea delle Fratte, 06156 Perugia, PG, Italy
| | - R Rosati
- Department of Surgery, Vita-Salute San Raffaele University, Via Olgettina, 58, 20132 Milan, MI, Italy; Division of General and Minimally Invasive Surgery, Humanitas Clinical and Research Center, Via Alessandro Manzoni, 56, 20089 Rozzano, MI, Italy
| | - A Sansonetti
- Division of General Surgery, Vannini Hospital, Via di Acqua Bullicante, 4, 00177 Rome, RM, Italy
| | - L Ansaloni
- Division of General Surgery I, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, BG, Italy
| | - A Zanoni
- Division of General Surgery, Rovereto Hospital, Corso Verona, 4, 38068 Rovereto, TN, Italy
| | - F Galli
- Department of Surgery, University of Insubria, Viale Luigi Borri, 57, 21100 Varese, VA, Italy
| | - G Dionigi
- Department of Surgery, University of Insubria, Viale Luigi Borri, 57, 21100 Varese, VA, Italy
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Kang SC, Kim HI, Kim MG. Low Serum Albumin Level, Male Sex, and Total Gastrectomy Are Risk Factors of Severe Postoperative Complications in Elderly Gastric Cancer Patients. J Gastric Cancer 2016; 16:43-50. [PMID: 27104026 PMCID: PMC4834620 DOI: 10.5230/jgc.2016.16.1.43] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 03/21/2016] [Accepted: 03/21/2016] [Indexed: 12/13/2022] Open
Abstract
Purpose It is well known that old age is a risk factor for postoperative complications. Therefore, this study aimed to explore the risk factors for poor postoperative surgical outcomes in elderly gastric cancer patients. Materials and Methods Between January 2006 and December 2015, 247 elderly gastric cancer patients who underwent curative gastrectomy were reviewed. In this study, an elderly patient was defined as a patient aged ≥65 years. All possible variables were used to explore the risk factors for poor early surgical outcomes in elderly gastric cancer patients. Results Based on multivariate analyses of preoperative risk factors, preoperative low serum albumin level (<3.5 g/dl) and male sex showed statistical significance in predicting severe postoperative complications. Additionally, in an analysis of surgery-related risk factors, total gastrectomy was a risk factor for severe postoperative complications. Conclusions Our study findings suggest that low serum albumin level, male sex, and total gastrectomy could be risk factors of severe postoperative complications in elderly gastric cancer patients. Therefore, surgeons should work carefully in cases of elderly gastric cancer patients with low preoperative serum albumin level and male sex. We believe that efforts should be made to avoid total gastrectomy in elderly gastric cancer patients.
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Affiliation(s)
- Sung Chan Kang
- Department of Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Hyun Il Kim
- Department of Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
| | - Min Gyu Kim
- Department of Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
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27
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Zhou CJ, Chen FF, Zhuang CL, Pang WY, Zhang FY, Huang DD, Wang SL, Shen X, Yu Z. Feasibility of radical gastrectomy for elderly patients with gastric cancer. Eur J Surg Oncol 2016; 42:303-11. [DOI: 10.1016/j.ejso.2015.11.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/30/2015] [Accepted: 11/20/2015] [Indexed: 12/30/2022] Open
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Urasaki T, Kodaira M, Hibino M, Yamagata S, Watanabe Y, Terazawa Y, Sano M, Kuriki K. Poorly Differentiated Gastric Adenocarcinoma Can Mimic Hilar Cholangiocarcinoma. Intern Med 2016; 55:1559-64. [PMID: 27301505 DOI: 10.2169/internalmedicine.55.5888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This report describes two cases with obstructive jaundice caused by poorly differentiated gastric adenocarcinoma. Computed tomography scans showed circumferential stenosis in the hilar bile ducts. Endoscopic retrograde cholangiopancreatography showed dilatation of the bilateral hepatic ducts and stenosis of the common hepatic ducts from the bifurcation of the bilateral hepatic ducts. The first diagnoses were hilar cholangiocarcinoma and biliary drainage decreased serum bilirubin; however, both patients died of cancer within a short period of time. Autopsies revealed lymphatic vessel invasion and possible subepithelial invasion by gastric adenocarcinoma into the hilar bile ducts. A differential diagnosis should thus be required in suspected cases of hilar cholangiocarcinoma.
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Yamanouchi K, Ogata S, Sakata Y, Tsuruoka N, Shimoda R, Nakayama A, Akutagawa T, Shirai S, Takeshita E, Yamamoto K, Fujimoto K, Iwakiri R. Effect of additional surgery after noncurative endoscopic submucosal dissection for early gastric cancer. Endosc Int Open 2016; 4:E24-9. [PMID: 26793781 PMCID: PMC4713180 DOI: 10.1055/s-0034-1393124] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 08/18/2015] [Indexed: 12/20/2022] Open
Abstract
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.
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Affiliation(s)
- Kohei Yamanouchi
- Department of Internal Medicine & Gastrointestinal Endoscopy, Saga Medical School, Saga 849-8501, Japan
| | - Shinichi Ogata
- Department of Gastroenterology, Saga Prefectural Medical Centre Koseikan, Saga 840-8571, Japan
| | - Yasuhisa Sakata
- Department of Internal Medicine & Gastrointestinal Endoscopy, Saga Medical School, Saga 849-8501, Japan
| | - Nanae Tsuruoka
- Department of Internal Medicine & Gastrointestinal Endoscopy, Saga Medical School, Saga 849-8501, Japan
| | - Ryo Shimoda
- Department of Internal Medicine & Gastrointestinal Endoscopy, Saga Medical School, Saga 849-8501, Japan
| | - Atsushi Nakayama
- Department of Internal Medicine & Gastrointestinal Endoscopy, Saga Medical School, Saga 849-8501, Japan
| | - Takashi Akutagawa
- Department of Internal Medicine & Gastrointestinal Endoscopy, Saga Medical School, Saga 849-8501, Japan
| | - Shimpei Shirai
- Department of Gastroenterology, Saga Prefectural Medical Centre Koseikan, Saga 840-8571, Japan
| | - Eri Takeshita
- Department of Internal Medicine & Gastrointestinal Endoscopy, Saga Medical School, Saga 849-8501, Japan
| | - Koji Yamamoto
- Department of Gastroenterology, Saga Prefectural Medical Centre Koseikan, Saga 840-8571, Japan
| | - Kazuma Fujimoto
- Department of Internal Medicine & Gastrointestinal Endoscopy, Saga Medical School, Saga 849-8501, Japan
| | - Ryuichi Iwakiri
- Department of Internal Medicine & Gastrointestinal Endoscopy, Saga Medical School, Saga 849-8501, Japan,Corresponding author Ryuichi Iwakiri, MD PhD Department of Internal Medicine and Gastrointestinal EndoscopySaga Medical SchoolSaga 849-8501Japan+81-952-342017
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Population-based outcomes research on treatment patterns and impact of chemotherapy in older patients with metastatic gastric cancer. J Cancer Res Clin Oncol 2015; 142:687-97. [DOI: 10.1007/s00432-015-2075-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 11/03/2015] [Indexed: 12/12/2022]
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Kiyokawa T, Hiki N, Nunobe S, Honda M, Ohashi M, Sano T, Yamaguchi T. Feasibility of Gastrectomy with Standard Lymphadenectomy for Patients Over 85 Years Old with Gastric Cancer. Ann Surg Oncol 2015; 22:3962-3969. [DOI: 10.1245/s10434-015-4489-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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32
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Mello AA, Leal MF, Rey JA, Pinto GR, Lamarão LM, Montenegro RC, Alves APNN, Assumpção PP, Borges BDN, Smith MC, Burbano RR. Deregulated Expression of SRC, LYN and CKB Kinases by DNA Methylation and Its Potential Role in Gastric Cancer Invasiveness and Metastasis. PLoS One 2015; 10:e0140492. [PMID: 26460485 PMCID: PMC4604160 DOI: 10.1371/journal.pone.0140492] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/25/2015] [Indexed: 12/29/2022] Open
Abstract
Kinases are downstream modulators and effectors of several cellular signaling cascades and play key roles in the development of neoplastic disease. In this study, we aimed to evaluate SRC, LYN and CKB protein and mRNA expression, as well as their promoter methylation, in gastric cancer. We found elevated expression of SRC and LYN kinase mRNA and protein but decreased levels of CKB kinase, alterations that may have a role in the invasiveness and metastasis of gastric tumors. Expression of the three studied kinases was also associated with MYC oncogene expression, a possible biomarker for gastric cancer. To understand the mechanisms that regulate the expression of these genes, we evaluated the DNA promoter methylation of the three kinases. We found that reduced SRC and LYN methylation and increased CKB methylation was associated with gastric cancer. The reduced SRC and LYN methylation was associated with increased levels of mRNA and protein expression, suggesting that DNA methylation is involved in regulating the expression of these kinases. Conversely, reduced CKB methylation was observed in samples with reduced mRNA and protein expression, suggesting CKB expression was found to be only partly regulated by DNA methylation. Additionally, we found that alterations in the DNA methylation pattern of the three studied kinases were also associated with the gastric cancer onset, advanced gastric cancer, deeper tumor invasion and the presence of metastasis. Therefore, SRC, LYN and CKB expression or DNA methylation could be useful markers for predicting tumor progression and targeting in anti-cancer strategies.
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Affiliation(s)
- Adriano Azevedo Mello
- Centro de Ciências Biológicas e da Saúde, Universidade Federal de Campina Grande, Campina Grande, PB, Brazil
| | - Mariana Ferreira Leal
- Disciplina de Genética, Departamento de Morfologia e Genética, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- * E-mail:
| | - Juan Antonio Rey
- Laboratorio de Oncogenética Molecular, Hospital Universitario La Paz, Madrid, Madrid, Spain
| | | | - Leticia Martins Lamarão
- Laboratório de Testes de Ácidos Nucleicos, Fundação Centro de Hemoterapia e Hematologia do Pará, Belém, PA, Brazil
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brazil
| | | | | | - Paulo Pimentel Assumpção
- Núcleo de Pesquisa em Oncologia, Hospital Universitário João de Barros Barreto, Universidade Federal do Pará, Belém, PA, Brazil
| | - Barbara do Nascimento Borges
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brazil
- Centro de Tecnologia Agropecuária, Instituto Socioambiental e dos Recursos Hídricos, Universidade Federal Rural da Amazônia, Belém, PA, Brazil
| | - Marília Cardoso Smith
- Disciplina de Genética, Departamento de Morfologia e Genética, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Rommel Rodriguez Burbano
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brazil
- Núcleo de Pesquisa em Oncologia, Hospital Universitário João de Barros Barreto, Universidade Federal do Pará, Belém, PA, Brazil
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Outcomes in elderly patients treated with a single-agent or combination regimen as first-line chemotherapy for recurrent or metastatic gastric cancer. Gastric Cancer 2015; 18:644-52. [PMID: 25098925 DOI: 10.1007/s10120-014-0405-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/13/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Palliative chemotherapy is used to prolong survival among elderly patients with inoperable gastric cancer (GC). We analyzed differences between single and combination first-line palliative chemotherapy among these patients. METHODS Included patients were >70 years old and were treated for GC at four clinical centers of the Catholic University of Korea. Baseline characteristics, the first-line chemotherapy regimen, treatment responses, toxicities, progression-free survival (PFS), and overall survival (OS) were evaluated. RESULTS Between 2005 and 2012, 178 > 70-year-old patients with GC received palliative chemotherapy using single or combination regimens. Median ages were 77 years (range 71-89) in the single regimen group (SG, 70 patients) and 73 years (range 71-81) in the combination group (CG, 108 patients). Patients in the SG received S-1 or capecitabine. The most common regimen in the CG was platinum combined with fluorouracil. The most common response in both groups was stable disease (SG, 45.7 %; CG, 48.1 %). In the SG and CG, median PFS times were 4.4 months (95 % confidence interval [CI] 2.85-5.95) and 4.1 months (95 % CI 2.62-5.57; P = 0.295), respectively; median OS times were 6.6 months (95 % CI 4.17-9.08) and 7.6 months (95 % CI 5.50-9.69; P = 0.782), respectively. Hematologic (P < 0.001) and non-hematologic toxicities (P < 0.001) were more frequent in the CG. The most common causes of chemotherapy cessation were disease progression in the SG and decreased performance status in the CG. CONCLUSIONS Single-agent treatment should be considered a first-line palliative chemotherapy option for elderly patients with GC.
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Risk factors for postoperative complications after gastrectomy in gastric cancer patients with comorbidities. Surg Today 2015; 46:224-8. [DOI: 10.1007/s00595-015-1175-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 03/11/2015] [Indexed: 01/20/2023]
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Takeshita H, Ichikawa D, Komatsu S, Kubota T, Okamoto K, Shiozaki A, Fujiwara H, Otsuji E. Surgical outcomes of gastrectomy for elderly patients with gastric cancer. World J Surg 2015; 37:2891-8. [PMID: 24081528 DOI: 10.1007/s00268-013-2210-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND This study was designed to determine the surgical outcomes of gastric cancer in elderly patients. This information can help establish appropriate treatment for these patients. METHODS A total of 1,193 patients with gastric cancer who underwent gastrectomy between 1995 and 2010 were enrolled in this retrospective study. The clinicopathologic features of 104 elderly patients (aged ≥80 years) were compared with those of 1,089 nonelderly patients. RESULTS (1) Tumors located in the lower-third of the stomach, differentiated cancer, and surgery with limited lymph node dissection were more common in elderly patients. However, there was no difference in the proportion of laparoscopic gastrectomy between elderly and nonelderly patients. (2) Although surgical complication rates were similar in the two groups, the operative mortality rate was higher in elderly patients (1.9 %) than in nonelderly patients (0.7 %). (3) Elderly patients had a significantly poorer overall survival rate, whereas the disease-specific survival rates of the two groups were similar. Limited lymph node dissection did not influence the disease-specific survival rate of elderly patients. (4) The median life expectancy of elderly gastric cancer survivors was 9.8 years in patients aged 80-84 years and 6.0 years in those ≥85 years. The patients with limited lymph node dissection had slightly better prognosis. CONCLUSIONS The treatment results in elderly patients were comparable to those in nonelderly patients. These findings suggest that R0 resection with at least limited lymph node dissection according to Japanese guidelines should be considered, even for elderly patients.
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Affiliation(s)
- Hiroki Takeshita
- Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto, 602-8566, Japan
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Jeuck TLA, Wittekind C. Gastric carcinoma: stage migration by immunohistochemically detected lymph node micrometastases. Gastric Cancer 2015; 18:100-8. [PMID: 24550066 DOI: 10.1007/s10120-014-0352-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 02/01/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Immunohistochemically detected micrometastases of the regional lymph nodes in previously pN0-classified gastric cancer have been incorporated in the TNM staging system. This study aims to determine the incidence of such micrometastases in gastric carcinoma and to investigate their impact on stage grouping and prognosis. METHODS Ninety-five patients with gastric carcinoma classified as pN0 by conventional histological examination were enrolled. All patients underwent gastric resection with regional lymphadenectomy between 2006 and 2010. A total of 2018 lymph nodes was obtained (median, 20 Lymph nodes) and immunohistostained with anti-pan cytokeratin antibody (KL1). RESULTS Micrometastases were detected in regional lymph nodes by immunohistostaining in 16 out of all 95 patients. Fourteen patients were upstaged by micrometastasis-positive regional lymph nodes. Three patients demonstrated lymph nodes with isolated tumor cells alone. A significantly higher incidence of micrometastases was observed in patients with diffuse histologic type (p = 0.007) and total gastrectomy (p = 0.007). When isolated tumor cells were also regarded as lymph node involvement, the recurrence rate was significantly higher for node-positive than for node-negative patients and for those younger than 70 years (33.3 and 6.7 %, respectively; p = 0.026; n = 39). Overall survival analysis revealed no significant difference between micrometastasis-positive and micrometastasis-negative patients. CONCLUSION Immunohistostaining of regional lymph nodes in node-negative gastric carcinoma patients leads to an increased detection of micrometastases with significant implications for the staging system. Although no impact on survival time was shown, the higher recurrence rate for node-positive patients younger than 70 years indicates a prognostic value of immunohistochemically detectable micrometastases.
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Affiliation(s)
- Theresa L A Jeuck
- Institute of Pathology, University Hospital Leipzig, Liebigstrasse 24, 04103, Leipzig, Germany,
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Qiu JF, Yang B, Fang L, Li YP, Shi YJ, Yu XC, Zhang MC. Safety and efficacy of laparoscopy-assisted gastrectomy for advanced gastric cancer in the elderly. Int J Clin Exp Med 2014; 7:3562-3567. [PMID: 25419398 PMCID: PMC4238507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 09/25/2014] [Indexed: 06/04/2023]
Abstract
To evaluate safety and efficacy of laparoscopy-assisted radical gastrectomy (LARG) for advanced gastric cancer patients aged 70 years or older. Clinical data were retrospectively collected from patients with IIA-IIIC gastric cancer who underwent LARG (n = 30) and open radical gastrectomy (ORG, n = 34) in Department of Gastrointestinal Surgery in the Ningbo First Hospital from January 2012 to December 2013. The mean operative time was longer in the LARG group than in the ORG group but there was no statistical difference between the two groups. The intraoperative blood loss (120 ± 52.7 ml vs 227.3 ± 146.9 ml), incidence of postoperative complication (23.0% vs 47%) were lower in the LARG group than those in the ORG group. In addition, the time to first flatus (2.9 ± 0.8 d vs 4.6 ± 1.2 d), time to first ambulation (1.2 ± 0.4 vs 4.1 ± 1.0 d), time of nasogastric intubation (2.5 ± 1.0 d vs 3.5 ± 1.4 d), and postoperative hospital stay (13.0 ± 4.2 d vs 16.9 ± 4.1 d) were significantly shorter in the LARG group than in the ORG group, respectively. No statistical difference in the number of harvested lymph nodes was noted between the two groups (30.2 ± 12.0 vs 28.1 ± 11.8, P > 0.05). LARG is safer, more effective and less invasive for the elderly patients with advanced gastric cancer.
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Affiliation(s)
- Jiang-Feng Qiu
- Department of Gastrointestinal Surgery, Ningbo First Hospital Ningbo 315010, China
| | - Bing Yang
- Department of Gastrointestinal Surgery, Ningbo First Hospital Ningbo 315010, China
| | - Lei Fang
- Department of Gastrointestinal Surgery, Ningbo First Hospital Ningbo 315010, China
| | - Yi-Ping Li
- Department of Gastrointestinal Surgery, Ningbo First Hospital Ningbo 315010, China
| | - Yi-Jiu Shi
- Department of Gastrointestinal Surgery, Ningbo First Hospital Ningbo 315010, China
| | - Xiu-Chong Yu
- Department of Gastrointestinal Surgery, Ningbo First Hospital Ningbo 315010, China
| | - Mou-Cheng Zhang
- Department of Gastrointestinal Surgery, Ningbo First Hospital Ningbo 315010, China
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Leal MF, Cirilo PDR, Mazzotti TKF, Calcagno DQ, Wisnieski F, Demachki S, Martinez MC, Assumpção PP, Chammas R, Burbano RR, Smith MC. Prohibitin expression deregulation in gastric cancer is associated with the 3' untranslated region 1630 C>T polymorphism and copy number variation. PLoS One 2014; 9:e98583. [PMID: 24879411 PMCID: PMC4039508 DOI: 10.1371/journal.pone.0098583] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 05/05/2014] [Indexed: 01/03/2023] Open
Abstract
PHB is a reported oncogene and tumor suppressor in gastric cancer. Here, we evaluated whether the PHB copy number and the rs6917 polymorphism affect its expression in gastric cancer. Down-regulation and up-regulation of PHB were observed in the evaluated tumors. Reduced expression was associated with tumor dedifferentiation and cancer initiation. The T allele of the rs6917 polymorphism was associated with reduced PHB mRNA levels. Moreover, the up-regulation of PHB appeared to be regulated by the gain of additional gene copies. Thus, PHB copy number variation and differential expression of the rs6917 polymorphism may play a role in PHB transcriptional regulation.
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Affiliation(s)
- Mariana Ferreira Leal
- Disciplina de Genética, Departamento de Morfologia e Genética, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Departamento de Ortopedia e Traumatologia, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- * E-mail:
| | - Priscila Daniele Ramos Cirilo
- Laboratório de Oncologia Experimental, Departamento de Radiologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Centro de Investigação Translacional em Oncologia, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | - Tatiane Katsue Furuya Mazzotti
- Laboratório de Oncologia Experimental, Departamento de Radiologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Centro de Investigação Translacional em Oncologia, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | - Danielle Queiroz Calcagno
- Disciplina de Genética, Departamento de Morfologia e Genética, Universidade Federal de São Paulo, São Paulo, SP, Brazil
- Núcleo de Pesquisa em Oncologia, Hospital Universitário João de Barros Barreto, Universidade Federal do Pará, Belém, PA, Brazil
| | - Fernanda Wisnieski
- Disciplina de Genética, Departamento de Morfologia e Genética, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Samia Demachki
- Núcleo de Pesquisa em Oncologia, Hospital Universitário João de Barros Barreto, Universidade Federal do Pará, Belém, PA, Brazil
| | - Margarita Cortes Martinez
- Laboratório de Oncologia Experimental, Departamento de Radiologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Centro de Investigação Translacional em Oncologia, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | - Paulo Pimentel Assumpção
- Núcleo de Pesquisa em Oncologia, Hospital Universitário João de Barros Barreto, Universidade Federal do Pará, Belém, PA, Brazil
| | - Roger Chammas
- Laboratório de Oncologia Experimental, Departamento de Radiologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Centro de Investigação Translacional em Oncologia, Instituto do Câncer do Estado de São Paulo, São Paulo, SP, Brazil
| | - Rommel Rodríguez Burbano
- Laboratório de Citogenética Humana, Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, PA, Brazil
| | - Marília Cardoso Smith
- Disciplina de Genética, Departamento de Morfologia e Genética, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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Ariake K, Ueno T, Takahashi M, Goto S, Sato S, Akada M, Naito H. E-PASS comprehensive risk score is a good predictor of postsurgical mortality from comorbid disease in elderly gastric cancer patients. J Surg Oncol 2013; 109:586-92. [DOI: 10.1002/jso.23542] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 12/03/2013] [Indexed: 12/17/2022]
Affiliation(s)
- Kyohei Ariake
- Department of Surgery; South Miyagi Medical Center; Oogawara Japan
| | - Tatsuya Ueno
- Department of Surgery; South Miyagi Medical Center; Oogawara Japan
| | | | - Shinji Goto
- Department of Surgery; South Miyagi Medical Center; Oogawara Japan
| | - Shun Sato
- Department of Surgery; South Miyagi Medical Center; Oogawara Japan
| | - Masanori Akada
- Department of Surgery; South Miyagi Medical Center; Oogawara Japan
| | - Hiroo Naito
- Department of Surgery; South Miyagi Medical Center; Oogawara Japan
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Chen CQ, Wu XJ, Yu Z, Bu ZD, Zuo KQ, Li ZY, Ji JF. Prognosis of patients with gastric cancer and solitary lymph node metastasis. World J Gastroenterol 2013; 19:8611-8618. [PMID: 24379578 PMCID: PMC3870506 DOI: 10.3748/wjg.v19.i46.8611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/07/2013] [Accepted: 10/18/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the relationship of solitary lymph node metastasis (SLNM) and age with patient survival in gastric cancer (GC).
METHODS: The medical records databases of China’s Beijing Cancer Hospital at the Peking University School of Oncology and Shanghai Tenth People’s Hospital affiliated to Tongji University were searched retrospectively to identify patients with histologically proven GC and SLNM who underwent surgical resection between October 2003 and December 2012. Patients with distant metastasis or gastric stump carcinoma following resection for benign disease were excluded from the analysis. In total, 936 patients with GC + SLNM were selected for analysis and the recorded parameters of clinicopathological disease and follow-up (range: 13-2925 d) were collected. The Kaplan-Meier method was used to stratify patients by age (≤ 50 years-old, n = 198; 50-64 years-old, n = 321; ≥ 65 years-old, n = 446) and by metastatic lymph node ratio [MLR < 0.04 (1/25), n = 180; 0.04-0.06 (1/25-1/15), n = 687; ≥ 0.06 (1/15), n = 98] for 5-year survival analysis. The significance of intergroup differences between the survival curves was assessed by a log-rank test.
RESULTS: The 5-year survival rate of the entire GC + SLNM patient population was 49.9%. Stratification analysis showed significant differences in survival time (post-operative days) according to age: ≤ 50 years-old: 950.7 ± 79.0 vs 50-64 years-old: 1697.8 ± 65.9 vs≥ 65 years-old: 1996.2 ± 57.6, all P < 0.05. In addition, younger age (≤ 50 years-old) correlated significantly with mean survival time (r = 0.367, P < 0.001). Stratification analysis also indicated an inverse relationship between increasing MLR and shorter survival time: < 0.04: 52.8% and 0.04-0.06: 51.1% vs≥ 0.06: 40.5%, P < 0.05. The patients with the shortest survival times and rates were younger and had a high MLR (≥ 0.06): ≤ 50 years-old: 496.4 ± 133.0 and 0.0% vs 50-65 years-old: 1180.9 ± 201.8 and 21.4% vs≥ 65 years-old: 1538.4 ± 72.4 and 37.3%, all P < 0.05. The same significant trend in shorter survival times and rates for younger patients was seen with the mid-range MLR group (0.04-0.06), but the difference between the two older groups was not significant. No significant differences were found between the age groups of patients with MLR < 0.04. Assessment of clinicopathological parameters identified age group, Borrmann type, histological type and tumor depth as the most important predictors of the survival rates and times observed for this study population.
CONCLUSION: GC patients below 51 years of age with MLR of SLNM above 0.06 have shorter life expectancy than their older counterparts.
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Liang YX, Deng JY, Guo HH, Ding XW, Wang XN, Wang BG, Zhang L, Liang H. Characteristics and prognosis of gastric cancer in patients aged ≥ 70 years. World J Gastroenterol 2013; 19:6568-6578. [PMID: 24151383 PMCID: PMC3801370 DOI: 10.3748/wjg.v19.i39.6568] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Revised: 07/28/2013] [Accepted: 08/06/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To elucidate the prognostic value of age for gastric cancer and identify the optimal treatment for elderly gastric cancer patients.
METHODS: We enrolled 920 patients with gastric cancer who underwent gastrectomy between January 2003 and December 2007 in our center. Patients were categorized into three groups: younger group (age < 50 years), middle-aged group (50-69 years), and elderly group (≥ 70 years). Clinicopathological features were compared among the three groups and potential prognostic factors were analyzed. The log-rank test was used to assess statistical differences between curves. Independent prognostic factors were identified by the Cox proportional hazards regression model. Stratified analysis was used to investigate the impact of age on survival at each stage. Cancer-specific survival was also compared among the three groups by excluding deaths due to reasons other than gastric cancer. We analyzed the potential prognostic factors for patients aged ≥ 70 years. Finally, the impact of extent of lymphadenectomy and postoperative chemotherapy on survival for each age group was evaluated.
RESULTS: In the elderly group, there was a male predominance. At the same time, cancers of the upper third of the stomach, differentiated type, and less-invasive surgery were more common than in the younger or middle-aged groups. Elderly patients were more likely to have advanced tumor-node-metastasis (TNM) stage and larger tumors, but less likely to have distant metastasis. Although 5-year overall survival (OS) rate specific to gastric cancer was not significantly different among the three groups, elderly patients demonstrated a significantly lower 5-year OS rate than the younger and middle-aged patients (elderly vs middle-aged vs younger patients = 22.0% vs 36.6% vs 38.0%, respectively). In the TNM-stratified analysis, the differences in OS were only observed in patients with II and III tumors. In multivariate analysis, only surgical margin status, pT4, lymph node metastasis, M1 and sex were independent prognostic factors for elderly patients. The 5-year OS rate did not differ between elderly patients undergoing D1 and D2 lymph node resection, and these patients benefited little from chemotherapy.
CONCLUSION: Age ≥ 70 years was an independent prognostic factor for gastric cancer after gastrectomy. D1 resection is appropriate and postoperative chemotherapy is possibly unnecessary for elderly patients with gastric cancer.
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The impact of old age on surgical outcomes of totally laparoscopic gastrectomy for gastric cancer. Surg Endosc 2013; 27:3990-7. [PMID: 23877760 DOI: 10.1007/s00464-013-3073-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 06/14/2013] [Indexed: 02/08/2023]
Abstract
BACKGROUND Old age is regarded as the risk factor of major abdominal surgery due to the lack of functional reserve and the increased presence of comorbidities. This study aimed to evaluate the impact of old age on the surgical outcomes of totally laparoscopic gastrectomy for gastric cancer. METHODS This study enrolled 389 gastric cancer patients who underwent totally laparoscopic gastrectomy at Hanyang University Guri Hospital and ASAN Medical Center. The patients were classified into two groups according to age as those older than 70 years and those younger than 70 years. Early surgical outcomes such as operation time, postoperative complications, time to first flatus, days until soft diet began, and hospital stay were evaluated. RESULTS No patient was converted to open surgery. The two groups differed significantly in terms of overall postoperative complication rate, time to first flatus, days until soft diet began, and hospital stay. The patients who underwent Roux-en-Y gastrojejunostomy differed in incidence of postoperative ileus but not in severe postoperative complication rate. CONCLUSIONS The results of this study demonstrated that old age can have an effect on the surgical outcomes of totally laparoscopic gastrectomy. This study especially showed that elderly patients are affected by the return of bowel movement after totally laparoscopic gastrectomy. On the other hand, however, it is presumed that old age has not had a serious impact on surgical outcomes in totally laparoscopic gastrectomy because no difference in the severe postoperative complication rate was observed.
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How can we predict the presence of missed synchronous lesions after endoscopic submucosal dissection for early gastric cancers or gastric adenomas? J Clin Gastroenterol 2013; 47:e17-22. [PMID: 22810109 DOI: 10.1097/mcg.0b013e31825c0b69] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
GOALS To identify predictive factors associated with the presence of missed synchronous lesions after endoscopic submucosal dissection (ESD) for gastric adenoma or early gastric cancer (EGC). BACKGROUND Secondary gastric neoplasms that develop during follow-up period after ESD for gastric adenoma or EGC are divided into metachronous lesions and missed synchronous lesions. METHODS ESD was performed in 250 patients with EGC or gastric adenoma. The patients with endoscopic follow-ups of <1 year, patients without curative resection, and patients with additional surgery were excluded from the study. Missed synchronous lesions were defined as secondary gastric neoplasms detected within one year of ESD but initially missed. We compared clinicopathologic factors between patients with missed synchronous lesions and patients without missed synchronous lesions. RESULTS Missed synchronous lesions were found in 11.6% of the patients (29/250). The occurrence of missed synchronous lesions had significant correlation with tumor number at the time of ESD and age in the univariate analysis. Tumor number at the time of ESD and age were significant independent predictive factors for presence of missed synchronous lesions by multivariate logistic regression analysis (odds ratio 5.302, P = 0.006; odds ratio 2.315, P = 0.040, respectively). Missed synchronous lesions tended to be smaller, often located in the same third of the stomach as the main lesions. CONCLUSIONS Tumor number at the time of ESD and age could be predictive factors for the presence of missed synchronous lesions after ESD. Careful endoscopic surveillance should be performed after ESD for multiple lesions or for elderly patients.
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Kim EJ, Seo KW, Yoon KY. Laparoscopy-assisted distal gastrectomy for early gastric cancer in the elderly. J Gastric Cancer 2012; 12:232-6. [PMID: 23346495 PMCID: PMC3543973 DOI: 10.5230/jgc.2012.12.4.232] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 10/18/2012] [Accepted: 10/20/2012] [Indexed: 12/21/2022] Open
Abstract
PURPOSE With an increase in life expectancy, more elderly patients are presenting with gastric cancer. As a result it is yet be resolved whether laparoscopy assisted distal gastrectomy is a suitable treatment for elderly patients with early gastric cancer. This study retrospectively compared surgical outcomes of laparoscopy assisted distal gastrectomy between elderly and nonelderly patients with gastric cancer. MATERIALS AND METHODS The study group was comprised of 316 patients who underwent laparoscopy assisted distal gastrectomy between April 2005 and December 2010. Of these patients, 93 patients whose ages were 65 years or more were compared with 223 patients who were younger. RESULTS There were no differences in the short term outcome or minor complication rate between the elderly patients and the nonelderly patients. The hospital stay was significantly longer and the major complication rate was significantly higher for the elderly patients compared with nonelderly patients. CONCLUSIONS Laparoscopy assisted distal gastrectomy for early gastric cancer in the elderly patients had comparable operation time and blood loss with the nonelderly group. However, the safety and advantage of laparoscopy assisted distal gastrectomy in the elderly patients need to be further studied in higher volume trials.
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Affiliation(s)
- Eun Ji Kim
- Department of Surgery, Kosin University College of Medicine, Busan, Korea
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Biondi A, Cananzi FC, Persiani R, Papa V, Degiuli M, Doglietto GB, D'Ugo D. The Road to Curative Surgery in Gastric Cancer Treatment: A Different Path in the Elderly? J Am Coll Surg 2012; 215:858-67. [DOI: 10.1016/j.jamcollsurg.2012.08.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 08/22/2012] [Accepted: 08/22/2012] [Indexed: 11/29/2022]
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Tural D, Selçukbiricik F, Serdengeçti S, Büyükünal E. A comparison of patient characteristics, prognosis, treatment modalities, and survival according to age group in gastric cancer patients. World J Surg Oncol 2012; 10:234. [PMID: 23121731 PMCID: PMC3542166 DOI: 10.1186/1477-7819-10-234] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Accepted: 10/18/2012] [Indexed: 12/15/2022] Open
Abstract
Background The aim of this study was to investigate age-specific incidence rates and to compare disease stage, treatment, and survival according to age group in patients with gastric adenocarcinoma. Methods Gastric cancer patients treated at our hospital between 1999 and 2010 were retrospectively evaluated. We divided the cases into two subgroups: group 1 consisted of patients older than 70 years at the time of treatment, and group 2 included patients aged 70 years or younger. In all, 151 patients over 70 years of age and 715 patients age 70 years or younger were analyzed. Categorical and continuous variables were summarized using descriptive statistics and compared using statistical software. Overall survival rates were estimated via the Kaplan-Meier method. Results Median age at diagnosis was 58 years (range: 22 to 90 years). Between 1999 and 2002 the annual median age for patients aged older than70 years was 9.8%, which increased to 20% between 2007 and 2010. The one-year survival rate for patients with metastatic disease (stage IV) was 10.9% (95% CI: 8.9% to 12.9%) and 27.8% (95% CI: 17.3% to 38.2%) in groups 1 and 2, respectively (P = 0.015). The five-year survival rate for patients with non-metastatic disease (in whom curative surgery was performed) was 15.5% (95% CI = 12% to 19%) and 26.9% (95% CI = 25.9% to 27.9%) in groups 1 and 2, respectively (P = 0.03). There were no significant differences in gender, tumor localization in the stomach, tumor histology, perineural invasion (PNI), lymphovascular invasion (LVI), tumor stage, or type of surgery between the two groups. However, fewer of the patients in group 1 underwent adjuvant treatment (P = 0.02) and palliative chemotherapy (P = 0.007) than group 2 patients that were non-metastatic and metastatic at presentation, respectively. Conclusions Groups 1 and 2 were similar in terms of histopathological features and surgical modality; however, the survival rate was lower in group 1 than in group 2. The incidence of gastric cancer was higher in the patients older than 70 years of age. Additional randomized studies are needed to further assess the safety and clinical benefit of chemotherapy in gastric cancer patients older than70 years of age.
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Affiliation(s)
- Deniz Tural
- Department of Internal Medicine, Division of Medical Oncology, Cerrahpasa Medical School, Istanbul University, Istanbul, 34098, Turkey.
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Lu Z, Lu M, Zhang X, Li J, Zhou J, Gong J, Gao J, Li J, Zhang X, Li Y, Shen L. Advanced or metastatic gastric cancer in elderly patients: clinicopathological, prognostic factors and treatments. Clin Transl Oncol 2012; 139:2111-6. [PMID: 23054754 DOI: 10.1007/s00432-013-1537-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 10/04/2013] [Indexed: 01/09/2023]
Abstract
PURPOSE To analyze the clinicopathological features, prognostic factors, treatment efficacy and safety among elderly patients with advanced or metastatic gastric cancer. METHODS Three hundred and nineteen patients aged 65 years and older, diagnosed with advanced or metastatic gastric cancer, were followed and data were retrospectively collected, reviewed and analyzed. RESULTS The elderly patients carried specific clinicopathological characteristics. Body mass index (BMI), number of metastatic lesions, ascites, Karnofsky performance score (KPS), tumor differentiation grade, lactate dehydrogenase (LDH) level, local treatment, and chemotherapy were the independent prognostic factors. Serum LDH level was superior to the serum CEA level in the prognosis of advanced or metastatic gastric cancer in older patients. Cisplatin-based regimen, chemotherapy cycles, metastatic lesions, LDH level, and supraclavicular lymph node metastasis were the independent prognostic factors in 220 patients receiving chemotherapy. The toxicity was mild and tolerable. CONCLUSION KPS, BMI and a well-differentiated histopathology were factors favoring longer survival, whereas elevated serum LDH and a greater number of metastatic lesions were associated with poor prognosis among those elderly patients. Cisplatin-based chemotherapy provided survival benefits and mild toxicity.
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Affiliation(s)
- Z Lu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Beijing Cancer Hospital and Institute, Peking University School of Oncology, Beijing, 100142, China
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Shim JH, Ko KJ, Yoo HM, Oh SI, Jeon DJ, Jeon HM, Park CH, Song KY. Morbidity and mortality after non-curative gastrectomy for gastric cancer in elderly patients. J Surg Oncol 2012; 106:753-6. [PMID: 22495554 DOI: 10.1002/jso.23121] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 03/23/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES This study examined the surgical outcome of non-curative resection in elderly patients with gastric cancer. METHODS The study reviewed 278 patients who underwent non-curative resection for advanced gastric cancer. The clinicopathological features of elderly patients (≥ 75 years, n = 257) and younger patients (<75 years, n = 21) were compared. RESULTS Although no difference was observed in terms of preoperative performance, there were distinct differences in terms of albumin level, presence of symptoms, and the rate of comorbidities between the two groups. The postoperative morbidity and mortality rate did not differ between the two groups. Age, preoperative performance status, preoperative transfusion, and presence of comorbidity were not independent predictors of postoperative complications. However, the extent of gastric resection and combined resection were closely related to postoperative complications in patients with non-curative gastrectomy. CONCLUSIONS In a setting of non-curative resection for gastric cancer, age was not a limiting factor. Rather, the risk of postoperative morbidity should be considered carefully in total gastrectomy and combined resection.
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Affiliation(s)
- Jung Ho Shim
- Division of Gastrointestinal Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Standard radical gastrectomy in octogenarians and nonagenarians with gastric cancer: are short-term surgical results and long-term survival substantial? J Gastrointest Surg 2012; 16:728-37. [PMID: 22350724 DOI: 10.1007/s11605-012-1835-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 02/02/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND The high incidence of gastric cancer among the octogenarians and nonagenarians (oldest old; age ≥ 80 years) is emerging as an important management issue. Herein, we report both the short-term outcomes and long-term survival results of standard radical gastrectomy in this group of patients. METHODS This was a retrospective review of 164 oldest old patients (older group) and 2,258 younger patients (age <80 years; younger group) with gastric cancer who underwent curative resection between January 1994 and December 2006. Clinicopathologic data, long-term survival, and prognostic factors were analyzed. RESULTS Clinical tumor stage did not differ between the two groups at the time of diagnosis. Higher Charlson comorbidity index scores (≥ 5) were observed in the older group than in the younger group; this was associated with higher postoperative morbidity (P = 0.035) and in-hospital mortality rates (P = 0.015) in the older group. At a median follow-up of 37.8 months, the overall survival rate for the older group was lower than that for the younger group (P < 0.001). However, the cumulative incidence of gastric cancer-related deaths was comparable between the two groups. Nodal involvement and metastatic to retrieved lymph node ratio were the only independent predictors of survival in the older group. CONCLUSIONS Patients in the older group had a higher postoperative morbidity rate but comparable cancer-specific survival. Careful patient selection for gastrectomy is warranted in elderly patients, particularly those with high-grade nodal involvement.
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Lee SR, Kim HO, Yoo CH. Impact of chronologic age in the elderly with gastric cancer. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 82:211-8. [PMID: 22493761 PMCID: PMC3319774 DOI: 10.4174/jkss.2012.82.4.211] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2011] [Revised: 02/07/2012] [Accepted: 02/20/2012] [Indexed: 12/13/2022]
Abstract
Purpose Although the incidence of gastric cancer has declined in the general population, it is the second most frequent cause of death due to malignancy in the world with its incidence in the elderly increasing as a result of increased life expectancy. This present study tried to find the optimal treatment for patients aged 75 years or older with gastric cancer through comparison of the clinicopathological characteristics, surgical outcomes, and identifying prognostic factors of survival. Methods Elderly patients who underwent gastric resection for gastric cancer from January, 1999 to February, 2009 (n = 470) were divided into two groups: very elderly patients, 75 years or older (n = 95), and younger elderly patients, between 65 and 74 years old (n = 365). Results Distinct characteristics of very elderly patients included more frequent underlying disease, deeper invasion, and more frequent lymph node metastasis. There were significant differences in overall survival between the two groups at stages III-B and IV. However, postoperative hospital stays, postoperative morbidity, mortality and early stage did not differ between curatively resected patients in the two groups. Conclusion Due to improved postoperative care, gastrectomy of gastric cancer is the treatment of choice in very elderly patients. Therefore, early diagnosis through regular medical screening and curative gastrectomy with lymph node dissection should be performed in very elderly gastric cancer patients.
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Affiliation(s)
- Sung Ryol Lee
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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