Appraisal of long-time outcomes after curative surgery in elderly patients with gastric cancer: a propensity score matching analysis

Study of the therapeutic strategy to improve survival outcomes from the perspective of perioperative conditions in elderly gastric cancer patients: a propensity score-matched analysis

BACKGROUND

Elderly gastric cancer patients (EGCPs) require treatment according to not just the stage of their cancer, but also to their general condition and organ function, and rather than full treatment, the appropriate amount of treatment is necessary.

METHODS

A total of 425 patients who underwent gastrectomy for primary gastric cancer in our institution between April 2013 and March 2020 were classified by age into two groups: elderly patients (EP, age ≥ 80 years, n = 89); and younger patients (YP, age < 80 years, n = 336). The preoperative, intraoperative, and postoperative conditions of the two groups were then compared. Propensity score matching (PSM) was performed, and factors affecting complications and survival outcomes were examined in detail. In addition, the necessary treatment strategy for EGCPs in the preoperative, intraoperative, and postoperative periods was investigated.

RESULTS

Of the preoperative factors, American Society of Anesthesiologists physical status (ASA-PS) was significantly higher, and respiratory function was significantly lower in the EP group than in the YP group, and the prognostic nutritional index (PNI) also tended to be lower. Of the intraoperative factors, there was no difference in the level of lymph node dissection. However, the EP group had significantly higher rates of postoperative pneumonia and anastomotic leakage. Of the postoperative factors, on simple comparison, postoperative long-term outcomes of the EP group were significantly worse (63.8% vs. 85.4%, p < 0.001), but there was no significant difference in disease-specific survival (DSS), and the DSS survival curves after PSM were almost identical, indicating that the survival rate in the EP group was decreased by death from other disease. Though the survival rate of laparoscopic surgery was significantly better than that of open surgery in the YP group, there was a significantly lower rate of postoperative complications in the EP group after PSM.

CONCLUSIONS

In EGCPs, one needs to be aware of short-term complications such as pneumonia and anastomotic leakage due to respiratory dysfunction and malnutrition that are present before surgery. Furthermore, to suppress deaths from other diseases that reduce postoperative survival rates, prevention of postoperative complications (particularly pneumonia) through minimally invasive surgery can be effective.

The impact of implementing current treatment modalities and female sex on gastric cancer outcomes, 2000-2016: a longitudinal nationwide cohort study

BACKGROUND

The implementation of current treatment modalities and their impact on nationwide gastric cancer outcomes remain poorly understood. Biological differences between females and males could impact survival. We aimed to analyze rates of gastric surgery, chemotherapy, and radiotherapy as well as changes in overall survival among gastric cancer patients diagnosed between 2000-2008 and 2009-2016, respectively, in Finland.

MATERIAL AND METHODS

Data on gastric cancer patients were collected from national registries. Cox regression analysis and the Kaplan-Meier method were used to analyze differences in survival.

RESULTS

We identified 9223 histologically confirmed gastric cancer patients. The rate of gastric surgery decreased from 44% (n = 2282) to 34% (n = 1368; p < 0.001). The proportion of gastric surgery patients who underwent preoperative oncological treatment increased from 0.5% (n = 12) to 16.2% (n = 222) between the calendar periods (p < 0.001) and stood at 30% in 2016. The median overall survival (OS) improved from 30 months [95% confidence interval (CI) 28-33] to 38 months (95%CI 33-42; p = 0.006) and the period 2009-2016 independently associated with a lower risk of death [hazard ratio (HR) 0.78, 95%CI 0.70-0.87] among patients who underwent gastric surgery. Females exhibited a lower risk of death (HR 0.88, 95%CI 0.81-0.97) among patients who underwent gastric surgery.

CONCLUSION

Preoperative oncological treatment was gradually introduced into clinical practice and OS among gastric surgery patients improved. Moreover, female surgical patients exhibited a better survival than male patients.

Safety and Feasibility of Gastrectomy in Super Elderly Patients (Aged ≥ 80): A Propensity Score-Matched Analysis

INTRODUCTION

The benefits of gastrectomy in elderly patients with gastric cancer (GC) remain unknown. This study was conducted to evaluate the short- and long-term outcomes of elderly patients with GC (≥ 80 years) who underwent gastrectomy.

METHODS

We enrolled 479 patients (Stages I-IV) who underwent gastrectomy with R0-1 resection. The patients were divided into an elderly group (E group; age ≥ 80 years) (n = 115) and a non-elderly group (NE group; age < 80 years) (n = 364). After propensity score matching (PSM) was performed, the short- and long-term outcomes were compared between the groups.

RESULTS

The rate of postoperative complications (Clavien-Dindo classification ≥ IIIa) in the two groups did not differ significantly (p = 0.657). Before PSM, the five-year overall survival (OS, 35.3% vs. 71.7%, p < 0.001) and disease-specific survival (DSS, 56.8% vs. 81.8%, p < 0.001) in the E group were significantly shorter than that in the NE group, respectively. On the other hand, significant differences between the E and NE groups were not shown in either the five-year OS (35.5% vs. 50.8%, p = 0.0985) or the five-year DSS (56.5% vs. 66.9%, p = 0.274) after PSM.

CONCLUSION

Gastrectomy for elderly patients with GC can be considered safe based on short-term outcomes. In terms of long-term results, elderly patients are not inferior to non-elderly patients if the patients' backgrounds are the same. On the other hand, the long-term outcomes of elderly GC patients who have various comorbidities are not satisfactory, so we should carefully consider the indications for gastrectomy.

Textbook outcome contributes to long-term prognosis in older adults with gastric cancer

PURPOSE

Textbook outcome (TO) is a composite quality measurement of short-term outcomes for evaluating surgical procedures. We investigated whether TO can be used to predict outcomes after curative gastric cancer (GC) surgery in older adults.

METHODS

We retrospectively analyzed 492 consecutive patients who underwent curative gastrectomy for GC from 2005 to 2017. Among these, 141 advanced-age patients were eligible. The patients were divided into two groups: those who achieved TO (a-TO group) and those who failed to achieve TO (f-TO group). In accordance with previous reports, TO consisted of eight metrics. We evaluated the association between TO and long-term survival.

RESULTS

TO was achieved 73 (52%) patients. The patients in the f-TO group had a significantly higher body mass index (P = 0.01), longer surgery time (P = 0.03), and more blood loss (P = 0.001). The metric with the lowest achievement rate was "no postoperative severe complication." The patients in the f-TO group had significantly shorter overall survival than those in the a-TO group (P = 0.03). Multivariable Cox regression analyses of overall survival revealed that an American Society of Anesthesiologists physical status classification of 3 (hazard ratio [HR], 3.28; 95% confidence interval [CI], 1.79-5.98; P < 0.0001) and f-TO (HR, 1.92; 95% CI, 1.09-3.39; P = 0.02) were significantly associated with poor overall survival.

CONCLUSION

TO can be used to predict outcomes after curative GC surgery in patients of advanced age.

The short-term and oncologic outcomes of younger VS older colorectal cancer patients undergoing primary surgery: a propensity score matching analysis

PURPOSE

The purpose of the current study is to analyze the difference of short-term and oncologic outcomes between younger and older colorectal cancer (CRC) patients who underwent primary CRC surgery using a propensity score matching (PSM) analysis.

METHODS

We retrospectively collected CRC patients who underwent primary surgery in a single clinical database from Jan 2011 to Jan 2020. The short-term and oncologic outcomes were compared between younger aged group and older aged group.

RESULTS

A total of 4599 patients were included in this study, and there were 4196 patients in older aged group and 403 patients in younger aged group. After 1:1 ratio PSM, there were 401 patients in each group. No significant difference was found in terms of baseline information after PSM (p>0.05). Younger aged group had larger retrieved lymph nodes before (p<0.001) and after PSM (p=0.001) than older aged group. In multivariate analysis, younger age was an independent predictor of better overall survival (OS) (p<0.001, HR=2.303, 95% CI=1.658-3.199) and disease-free survival (DFS) (p=0.008, HR=1.425, 95% CI=1.098-1.850). In terms of different tumor stage after PSM, younger aged group had better OS than older group in stage II (p<0.001) and stage IV (p=0.028) CRC, and younger aged group had better DFS than older group in stage II (p=0.016) CRC.

CONCLUSION

Younger CRC patients had larger retrieved lymph nodes and better prognosis than older CRC patients after primary CRC surgery.

Prognostic factors for elderly gastric cancer patients who underwent gastrectomy

Background

Patients with gastric cancer are aging in Japan. It is not clear which patients and which surgical procedures have survival benefits after gastrectomy. A multivariate analysis was performed.

Methods

The medical records of 166 patients aged ≥ 80 years who underwent gastrectomy without macroscopic residual tumors were retrospectively reviewed. Univariate and multivariate analyses using Cox proportional hazard models were performed to detect prognostic factors for overall survival.

Results

In univariate analyses, age (≥ 90 vs. ≥ 80, < 85), performance status (3 vs. 0), American Society of Anesthesiologists physical status (ASA-PS) (3, 4 vs. 1, 2), Onodera’s prognostic nutritional index (< 40 vs. ≥ 45), the physiological score of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) (≥ 40 vs. ≥ 20, ≤ 29), surgical approach (laparoscopic vs. open), extent of gastrectomy (total, proximal vs. distal), extent of lymphadenectomy (D1 vs. ≥ D2), pathological stage (II–IV vs. I), and residual tumor (R1 vs. R0) were significantly correlated with worse overall survival. Multivariate analysis revealed that ASA-PS [3, 4 vs. 1, 2, hazard ratio (HR) 2.30, 95% confidence interval (CI) 1.24–4.24], extent of gastrectomy (total vs. distal, HR 2.17, 95% CI 1.10–4.31) (proximal vs. distal, HR 4.05, 95% CI 1.45–11.3), extent of lymphadenectomy (D0 vs. ≥ D2, HR 12.4, 95% CI 1.58–97.7), and pathological stage were independent risk factors for mortality.

Conclusions

ASA-PS was a useful predictor for postoperative mortality. Gastrectomy including cardia is best avoided.

The outcome of young vs. old gastric cancer patients following gastrectomy: a propensity score matching analysis

Purpose

The purpose of the current study was to compare the postoperative complications, overall survival and disease-free survival in young and old gastric cancer patients after gastrectomy using propensity score matching (PSM).

Methods

Adult patients (aged ≥ 18 years) who underwent gastrectomy for gastric cancer in a single clinical center from January 2013 to December 2017 were enrolled continuously for retrospective analysis. To minimize the selection bias between the young and old groups, the PSM was conducted in this study.

Results

A total of 558 patients were included in this study, with 51 patients in the young group (aged ≤ 45 years) and 507 patients in the old group (aged > 45 years). After 1:1 matching according to PSM, 51 patients in the young group were matched to 51 patients in the old group. After PSM, there was no difference in the baseline information. In terms of short-term outcomes, no difference was found in operation time (P = 0.190), intraoperative blood loss (P = 0.336), retrieved lymph nodes (P = 0.948), blood transfusion (P = 0.339), postoperative hospital stay (P = 0.194), or postoperative complications (P = 0.477) between the two groups. For overall survival, no statistically significant difference was found in all stages (P = 0.383), stage I (P = 0.431), stage II (P = 0.875) or stage III (P = 0.446) gastric cancer. Furthermore, regarding disease-free survival, no differences were found between the two groups in all stages (P = 0.378), stage I (P = 0.431), stage II (P = 0.879) or stage III (P = 0.510) gastric cancer.

Conclusion

Age might not be an independent prognostic factor for short-term outcomes, OS, or DFS in gastric cancer patients who underwent gastrectomy. The pTNM stage of GC might be an independent prognostic factor for OS and DFS.