Impact of age on stage-specific mortality in patients with gastric cancer: A long-term prospective cohort study

Lee, Jae Gon; Kim, Shin Ah; Eun, Chang Soo; Han, Dong Soo; Kim, Yong‐Sung; Choi, Bo Youl; Song, Kyu Sang; Kim, Hyun Ja; Park, Chan Hyuk

doi:10.1371/journal.pone.0220660

“…Recent research suggested that the impact of age as an independent risk factor on gastric cancer may differ depending on the cancer stage [ 62 ]. Although the finding of age as an independent risk factor in this study had a certain particular value, large-scale clinical data is urgently needed to verify and thus to direct the establishment of a clinical treating scheme.…”

Section: Discussionmentioning

confidence: 99%

Progressive and Prognostic Performance of an Extracellular Matrix-Receptor Interaction Signature in Gastric Cancer

Yang

¹

,

Chen

²

,

Mao

³

et al. 2020

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The role of an extracellular matrix- (ECM-) receptor interaction signature has not been fully clarified in gastric cancer. This study performed comprehensive analyses on the differentially expressed ECM-related genes, clinicopathologic features, and prognostic application in gastric cancer. The differentially expressed genes between tumorous and matched normal tissues in The Cancer Genome Atlas (TCGA) and validation cohorts were identified by a paired t -test. Consensus clusters were built to find the correlation between clinicopathologic features and subclusters. Then, the least absolute shrinkage and selection operator (lasso) method was used to construct a risk score model. Correlation analyses were made to reveal the relation between risk score-stratified subgroups and clinicopathologic features or significant signatures. In TCGA (26 pairs) and validation cohort (134 pairs), 25 ECM-related genes were significantly highly expressed and 11 genes were downexpressed in gastric cancer. ECM-based subclusters were slightly related to clinicopathologic features. We constructed a risk score model = 0.081 ∗ log 2 CD 36 + 0.043 ∗ log 2 COL 5 A 2 + 0.001 ∗ log 2 ITGB 5 + 0.039 ∗ log 2 SDC 2 + 0.135 ∗ log 2 SV 2 B + 0.012 ∗ log 2 THBS 1 + 0.068 ∗ log 2 VTN + 0.023 ∗ log 2 VWF . The risk score model could well predict the outcome of patients with gastric cancer in both training ( n = 351 , HR: 1.807, 95% CI: 1.292-2.528, P = 0.00046 ) and validation ( n = 300 , HR: 1.866, 95% CI: 1.347-2.584, P = 0.00014 ) cohorts. Besides, risk score-based subgroups were associated with angiogenesis, cell adhesion molecules, complement and coagulation cascades, TGF-beta signaling, and mismatch repair-relevant signatures ( P < 0.0001 ). By univariate (1.845, 95% CI: 1.382-2.462, P < 0.001 ) and multivariate (1.756, 95% CI: 1.284-2.402, P < 0.001 ) analyses, we regarded the risk score as an independent risk factor in gastric cancer. Our findings revealed that ECM compositions became accomplices in the tumorigenesis, progression, and poor survival of gastric cancer.

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“…Although considered as an independent risk factor for GC-related mortality, the impact of age may differ depending on the stage of cancer. 27 In the Dutch CRITICS trial, out of 788 randomized patients, 22% were older (≥70 years) adults with resectable GC who received preoperative chemotherapy (3 cycles of EOX/ECX), followed by surgery, and postoperative radio and/or chemotherapy. Although they frequently (77%) experienced severe toxicity, and thus received lower relative dose intensities during preoperative chemotherapy, equal proportion (80%) of older patients underwent curative surgery as compared to younger ones.…”

Section: Elderlymentioning

confidence: 99%

<p>Treatment of Gastric Cancer Patients During COVID-19 Pandemic: The West is More Vulnerable</p>

Polkowski¹,

Sędłak²,

Rawicz‐Pruszyński³

2020

CMAR

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The outbreak of the COVID-19 is currently the biggest international concern. Treatment of gastric cancer (GC) patients in the pandemic era with high hospital burden and under severe oncological/surgical resource constraints should implicate a need for resource reallocation with a new "pandemic" GC treatment algorithm. The neoadjuvant/perioperative (radio-)chemotherapy is applied in the majority of advanced GC cases with poor postoperative therapy compliance. In the East, radical surgery is frequently used in the first instance, with adjuvant chemotherapy reserved for patients with a high risk of recurrence. Moreover, the elderly population might be effectively treated by surgery alone, thus saving oncological resources for younger people who need a more aggressive approach. In this framework, prioritization is a key concept based on the severity of symptoms and the need for urgent (surgical) intervention. High-risk and marginally effective surgery should be replaced with definitive radio-and/or chemotherapy. The pandemic framework to provide optimal care for GC patients must be based on multidisciplinary decision-making and include all anti-cancer treatment options: surgery, systemic therapy, and radiotherapy. The priority and staffing dictate adherence to the new algorithm. We believe that these priorities may improve the delivery of care to all, including elderly GC patients.

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“…Patients with stage IV disease, who underwent palliative treatment, and who received support care alone were included. Margins and lymphadenectomy performed and not reported (19) . In our cohort, aging significantly increased complications and shortened OS.…”

Section: Discussionmentioning

confidence: 99%

Impact of Aging in the Surgical Outcomes of Gastric Cancer Patients

Dias

¹

,

Pereira

²

,

Ramos

³

et al. 2021

Arq. Gastroenterol.

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BACKGROUND: As age advances, a higher burden of comorbidities and less functional reserve are expected, however, the impact of aging in the surgical outcomes of gastric cancer (GC) patients is unknown. OBJECTIVE: The aim of this study is to evaluate surgical outcomes of GC patients according to their age group. METHODS: Patients submitted to gastrectomy with curative intent due to gastric adenocarcinoma were divided in quartiles. Each group had 150 patients and age limits were: ≤54.8, 54.9-63.7, 63.8-72, >72. The outcomes assessed were: postoperative complications (POC), 90-day postoperative mortality, disease-free survival (DFS) and overall survival (OS). RESULTS: Major surgical complications were 2.7% in the younger quartile vs 12% for the others (P=0.007). Major clinical complications raised according to the age quartile: 0.7% vs 4.7% vs 5.3% vs 7.3% (P<0.042). ASA score and age were independent risk factors for major POC. The 90-day mortality progressively increased according to the age quartile: 1.3% vs 6.0% vs 7.3% vs 14% (P<0.001). DFS was equivalent among quartile groups, while OS was significantly worse for those >72-year-old. D2 lymphadenectomy only improved OS in the three younger quartiles. Age >72 was an independent risk factor for worse OS (hazard ratio of 1.72). CONCLUSION: Patients <55-year-old have less surgical complications. As age progresses, clinical complications and 90-day mortality gradually rise. OS is worse for those above age 72, and D2 lymphadenectomy should be individualized after this age.

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Impact of age on stage-specific mortality in patients with gastric cancer: A long-term prospective cohort study

Cited by 21 publications

References 24 publications

Progressive and Prognostic Performance of an Extracellular Matrix-Receptor Interaction Signature in Gastric Cancer

Progressive and Prognostic Performance of an Extracellular Matrix-Receptor Interaction Signature in Gastric Cancer

<p>Treatment of Gastric Cancer Patients During COVID-19 Pandemic: The West is More Vulnerable</p>

Impact of Aging in the Surgical Outcomes of Gastric Cancer Patients

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