Characteristics and prognosis of gastric cancer in patients aged ≥ 70 years

Abstract

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.

Lymphadenectomy in elderly/high risk patients: should it be different?

“…Although in last years literature reports many studies concerning oncologic gastric surgery in elderly patients, there is still no homogeneity in the definition of this subgroup, and an established cut-off age seems far to be determined: in facts, if some authors defined as elderly patients with more than 65 years (14), other authors reported thresholds of 70, 75 or 80 years (3,11,(15)(16)(17), so that it is not easy to compare results from different studies.…”

“…Many studies showed similar DSS rates when comparing the efficacy of D2 versus D1 in both young and elderly gastric cancer patients (3,11,16), although paradoxically a recent Italian RCT described a better DSS in patients aged ≥70 years after D1 lymphadenectomy (42).…”

“…At first, gastric cancer in the elderly presents a higher predominance in males, in contrast to the younger group (7,11,26). Concerning macroscopical features, many studies reported a prevalence of tumor in the lower third of the stomach among the elderly (9,27).…”

“…Also gross appearance seems to differ from that of young patients, with a higher prevalence of superficial depressed type in the elderly when early gastric cancer is considered, and a prevalence of ulcerative tumors (according to Borrmann's classification), in contrast to the prevalence of the diffuse infiltrative type in the young population (26). Moreover, an increase of the differentiated type together with aging has been described (11), and considering early stages of disease, poorly differentiated and signet ring-cell carcinomas account for only 10% of the cases (26).…”

“…Moreover, it is important to underline that overall survival (OS) in the elderly is clearly influenced by coexisting comorbidities. When disease-specific survival (DSS) is analyzed, it seems that prognosis in the elderly patients is not worse than in the control group (9)(10)(11), and even when it results to be worse, it is often a consequence of a more advanced disease at the time of diagnosis (8).…”