Challenges in the treatment of gastric cancer in the older patient

Joharatnam‐Hogan, Nalinie; Shiu, Kai Keen; Khan, Khurum

doi:10.1016/j.ctrv.2020.101980

Cited by 93 publications

(75 citation statements)

References 83 publications

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“…We also found significant differences in clinicopathological characteristics and prognostic factors between different age groups of GC patients. However, there is increasing evidence that the senile GC patients with radical gastrectomy have a relatively longer OS than those without[ 57 , 58 ]. Therefore, according to the findings in our study, the preoperative alleviation of inflammatory status should be emphasized for elderly GC patients after their surgical benefits have been evaluated to prevail over their surgical risks.…”

Section: Discussionmentioning

confidence: 99%

Comparison of prognostic factors in different age groups and prognostic significance of neutrophil-lymphocyte ratio in patients with gastric cancer

Huang

Han

2020

WJGO

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BACKGROUND Gastric cancer (GC) is one of the most common malignant tumors in the world. Although in recent years tremendous progress has been made in its early detection, the postoperative overall survival (OS) of GC patients remains extremely low. A number of studies have shown that age, to varying degrees, affects the prognosis of patients with GC. Therefore, this study retrospectively analyzed the clinical and pathologic data of patients with GC to explore the differences in the clinical characteristics and prognostic factors in different age groups. AIM To explore the difference in clinicopathological characteristics and prognostic factors in GC patients in different age groups. METHODS In this retrospective study, we analyzed 1037 GC patients admitted to Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from May 2010 to January 2013. The patients were divided into two groups based on age: Younger group (less than 70 years old) and older group (no less than 70 years old). In the younger group, we subdivided the patients in two subgroups by a cut-off value of 45 years. The clinical features and prognostic factors were analyzed in both groups. Subsequently, we retrieved studies that evaluated the predictive role of neutrophil-lymphocyte ratio (NLR) by searching two medical databases, PubMed and EMBASE, to conduct a meta-analysis. Random-effects model was used to pool the data. RESULTS In the retrospective study, the mean OS time of the younger group (64.7 mo) was significantly longer than that of the older group (48.1 mo) ( P < 0.001). Among patients under 70 years of age, hospitalization time, tumor–node–metastasis (TNM) stage, vascular invasion, and preoperative low pre-albumin were independently associated with OS ( P < 0.005). In patients aged 70 years and above, TNM stage, esophageal invasion, histological type, and preoperative NLR were independent factors for OS ( P < 0.05). The OS of these older patients was also significantly shorter ( P < 0.05). In the meta-analysis, 19 retrieved studies included a total of 8312 patients, among whom 3558 had elevated NLR values. The results showed that high NLR value was a risk factor for the prognosis of GC ( P < 0.01). CONCLUSION The OS of elderly patients is significantly worse than that of younger patients. There are significant differences in clinicopathological characteristics and prognostic factors between younger and older patients. NLR is a convenient, inexpensive, and reproducible marker that can be used as an important predictor of the prognosis of GC.

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Section: Discussionmentioning

confidence: 99%

Comparison of prognostic factors in different age groups and prognostic significance of neutrophil-lymphocyte ratio in patients with gastric cancer

Huang

Han

2020

WJGO

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“…[ 1 ] Lines of treatment include gastric resection, radiotherapy, chemotherapy, and biologic therapy. [ 6 ]…”

Section: Treatment Of Gastric Carcinomamentioning

confidence: 99%

“…[ 5 ] The mainstay of therapy of gastric carcinoma is surgical resection with adjuvant chemotherapy, with or without radiotherapy according to the stage of the disease. [ 6 ] However, cases with distant metastasis still have a poor prognosis and the median overall survival rate of these cases is less than 1 year. [ 1 ] Hence, studies on gastric carcinoma are vitally needed for a better understanding of the pathogenesis of the disease, to improve the prevention strategies, and to develop new methods for early detection and better management of this disease.…”

Section: Introductionmentioning

confidence: 99%

“…[ 7 ] Since early cases of gastric carcinoma are usually asymptomatic, the role of the primary care physicians in early detection of patients with gastric carcinoma has emerged in recent years and represents an important clue for the improvement of the therapeutic outcomes of this disease. [ 4 6 ] This review sheds light on gastric carcinoma given the recent trends regarding its prevalence, risk factors, types, clinical picture, methods of diagnosis, possible lines of management, and the role of primary care.…”

Section: Introductionmentioning

confidence: 99%

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Gastric carcinoma: Insights into risk factors, methods of diagnosis, possible lines of management, and the role of primary care

Marghalani

Salman

Faqeeh

et al. 2020

J Family Med Prim Care

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Gastric carcinoma represents the second most common type of malignancy that contributes to cancer-related mortality worldwide. However, the geographic incidence of gastric carcinoma had changed over the last few decades, possibly due to increased hygiene, increased awareness of the importance of healthy nutrition, and increased rates of eradication of Helicobacter pylori infection. Gastric carcinoma consists of two pathological variants, intestinal and diffuse. Early cases of gastric carcinoma may be asymptomatic. However, advanced cases may present with significant weight loss, dysphagia, abdominal pain, vomiting, and even severe upper gastrointestinal bleeding. Patients at high risk of developing gastric carcinoma should be adequately screened at primary healthcare centers for early detection and effective management. Lines of treatment vary according to the stage of the disease but surgical resection of the tumor with regional lymphadenectomy remains the gold standard of therapy. This review sheds light on gastric carcinoma given the recent trends regarding its prevalence, risk factors, types, clinical picture, methods of diagnosis, possible lines of management, and the role of primary care.

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“…Due to its peak prevalence in the 7th decade, the proportion of aged patients with GC will increase with the progression of aging populations [2,3]. Current treatment guidelines for GC are primarily based on evidence from randomized clinical trials (RCT) conducted in young patients, rather than in elderly patients, despite that these population have been corroborated to have poor prognosis [2].…”

Section: Introductionmentioning

confidence: 99%

Development and Validation of a Prognostic Nomogram to Predict Overall Survival of Elderly Patients with Gastric Cancer

Zhou

Ding

Wang

et al. 2020

Preprint

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Background Gastric cancer (GC) is one of the most common malignant tumors of digestive tract origin in China. The proportion of elderly patients with gastric cancer (GC) gradually increases as the population ages. We aimed to develop a prognostic nomogram for prediction of elderly (≥ 75 years old) GC patients in overall survival (OS). Patients and Methods Patients with GC from 2005 to 2014 were selected from the Surveillance, Epidemiology, and End Result (SEER) database and randomly assigned to development and validation sets. The variables for establishing nomogram were confirmed by univariate and multivariate Cox proportional hazard analysis based on the development set. The predictive accuracy and discriminative ability of the model was evaluated using the receiver operating characteristic (ROC) curve, the concordance index (C-index) and calibration curves, while its clinical utility was assessed using decision curve analysis (DCA) and Kaplan-Meier curve. Results A total of 1445 patients were included in this study. The nomogram was developed including histologic grade, AJCC stage T, N, M and surgery according to the univariate and multivariate cox regression analysis, the area under the time-dependent receiver operating characteristic curve (AUC) and Occam’s Law of Razor. The C-index of the nomogram was higher than the TNM system in the training cohort (0.710 vs 0.652, p < 0.001), which was also confirmed in the validation cohort (0.701 vs 0.643, p < 0.001); and high AUCs were noted in both development and validation sets. The nomogram showed good discrimination and calibration in both development and validation sets. The DCA curves showed that the nomogram had better clinical utility compared to the AJCC stage model. In addition, participants could be divided into three disparate risk groups (low, moderate, high) by the nomogram. Conclusion This study established a prognostic nomogram that improved the performance of the AJCC staging system with incorporation of risk factors to better predict the short-term survival in elderly GC patients.

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Challenges in the treatment of gastric cancer in the older patient

Cited by 93 publications

References 83 publications

Comparison of prognostic factors in different age groups and prognostic significance of neutrophil-lymphocyte ratio in patients with gastric cancer

Comparison of prognostic factors in different age groups and prognostic significance of neutrophil-lymphocyte ratio in patients with gastric cancer

Gastric carcinoma: Insights into risk factors, methods of diagnosis, possible lines of management, and the role of primary care

Development and Validation of a Prognostic Nomogram to Predict Overall Survival of Elderly Patients with Gastric Cancer

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