Long-term outcomes and prognostic factors with non-curative endoscopic submucosal dissection for gastric cancer in elderly patients aged ≥ 75 years

Toya, Yosuke; Endo, Masaki; Nakamura, Shotaro; Akasaka, Risaburo; Yanai, Shunichi; Kawasaki, Keisuke; Koeda, Keisuke; Eizuka, Makoto; Fujita, Yuka; Uesugi, Noriyuki; Ishida, Kazuyuki; Sugai, Tamotsu; Matsumoto, Takayuki

doi:10.1007/s10120-018-00913-9

Cited by 49 publications

(41 citation statements)

References 35 publications

(57 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Four objective indexes were identified in the search; PNI, CONUT, NRI and GNRI, of which 17 studies investigated PNI [43,46,50,[53][54][55][56][57][58][59][60][61][62][63][64][65][66], three GNRI [48,56,62], two CONUT [56,57] and two investigated NRI [36,68]. All but one study [68] investigated the use of objective indexes in surgical patients.…”

Section: Objective Indexesmentioning

confidence: 99%

Relationship between markers of malnutrition and clinical outcomes in older adults with cancer: systematic review, narrative synthesis and meta-analysis

et al. 2020

View full text Add to dashboard Cite

Malnutrition predicts poorer clinical outcomes for people with cancer. Older adults with cancer are a complex, growing population at high risk of weight-losing conditions. A number of malnutrition screening tools exist, however the best screening tool for this group is unknown. The aim was to systematically review the published evidence regarding markers and measures of nutritional status in older adults with cancer (age ≥ 70). A systematic search was performed in Ovid Medline, EMBASE, Web of Science, CINAHL, British Nursing Database and Cochrane CENTRAL; search terms related to malnutrition, cancer, older adults. Titles, abstracts and papers were screened and quality-appraised. Data evaluating ability of markers of nutritional status to predict patient outcomes were subjected to meta-analysis or narrative synthesis. Forty-two studies, describing 15 markers were included. Meta-analysis found decreased food intake was associated with mortality (OR 2.15 [2.03–4.20] p = < 0.00001) in univariate analysis. Prognostic Nutritional Index (PNI) was associated with overall survival (HR 1.89 [1.03–3.48] p = 0.04). PNI markers (albumin, total lymphocyte count) could be seen as markers of inflammation rather than nutrition. There a suggested relationship between very low body mass index (BMI) (<18 kg/m2) and clinical outcomes. No tool was identified as appropriate to screen for malnutrition, as distinct from inflammatory causes of weight-loss. Risk of cancer-cachexia and sarcopenia in older adults with cancer limits the tools analysed. Measures of food intake predicted mortality and should be included in clinical enquiry. A screening tool that distinguishes between malnutrition, cachexia and sarcopenia in older adults with cancer is needed.

show abstract

Section: Objective Indexesmentioning

confidence: 99%

Relationship between markers of malnutrition and clinical outcomes in older adults with cancer: systematic review, narrative synthesis and meta-analysis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…A recent study identified the Charlson comorbidity index (CCI) as being a significant prognostic factor in elderly patients who underwent ER for SESCC. 78 In patients who underwent ESD for EGC, the American Society of Anesthesiologists Physical Status (ASA-PS), 99 CCI, 60,100 Eastern Cooperative Oncology Group Performance Status (ECOG-PS), 100 and prognostic nutritional index (PNI) 100,101 were identified as useful prognostic indicators; however, the attained results were not consistent across the studies, 32,60,[99][100][101] so more research is likely warranted. Furthermore, these commonly used unidimensional measures cannot fully do justice to the heterogeneity of elderly patients.…”

Section: Assessment Of Physical Condition In Elderly Patients With Eamentioning

confidence: 99%

“…This trend was more pronounced in elderly patients. 60 Therefore, among elderly individuals, the prognosis for those who underwent ER with curability C-2 may not be mainly associated with the gastric cancer.…”

Section: Prognosis In Patients Who Underwent Er With Curability C-2mentioning

confidence: 99%

Management following endoscopic resection in elderly patients with early‐stage upper gastrointestinal neoplasia

Hatta

Gotoda

Koike

et al. 2020

Digestive Endoscopy

View full text Add to dashboard Cite

With the ongoing increase in the aging population in Japan, the number of elderly patients among the total population with upper gastrointestinal (GI) neoplasia has also been increasing. As elderly patients present unique age‐related variations in their physical condition, the therapeutic approach for upper GI neoplasia should be differentiated between elderly and nonelderly patients. According to the existing guidelines, additional treatment is the standard therapy in patients who undergo endoscopic resection (ER) with a possible risk of lymph node metastasis (LNM) for upper GI neoplasia. However, due to the relatively low rate of LNM, applying additional treatment in all elderly patients may be excessive. Although additional treatment has the advantage of reducing cancer‐specific mortality, its disadvantages include deteriorated quality of life, complications, and mortality in surgery. In patients with early gastric cancer, we propose treatment decisions be made using a risk‐scoring system for LNM and upon considering the physical condition of the patient after ER with curability C‐2. In those with superficial esophageal squamous cell carcinoma with a possible risk of LNM after ER, selective chemoradiotherapy may be a less‐invasive treatment option, although the present standard treatment is esophagectomy. When considering the treatment decision, achieving a “cure” of the tumor has been regarded as critical. However, as the main cause of mortality in elderly patients with ER for upper GI neoplasia is noncancer‐related death, both achieving a “cure” and also a good level of “care” is important in the management of elderly patients.

show abstract

“…80 In elderly patients with gastric cancer, it is necessary to evaluate not only the risk for LNM but also the condition of the patients because heterogeneity in the aging process leads to a diverse range of age-related declines in health and physical status among elderly patients. To date, several indices for evaluating the condition of patients, such as prognostic nutritional index, 81,82 Charlson comorbidity index, 81,83 and American Society of Anesthesiologists' Physical Status, 84,85 have been reported as indicators for the prognosis in patients with EGCs. However, some reports have shown conflicting results.…”

Section: Management After Noncurative Resectionmentioning

confidence: 99%

“…However, some reports have shown conflicting results. 81,[83][84][85][86] Therefore, for deciding treatment strategy in elderly patients with noncurative resection of ESD for EGCs, the establishment of a reliable tool for predicting the prognosis is demanded.…”

Section: Management After Noncurative Resectionmentioning

confidence: 99%

A Recent Argument for the Use of Endoscopic Submucosal Dissection for Early Gastric Cancers

et al. 2020

View full text Add to dashboard Cite

Endoscopic submucosal dissection (ESD) has become the standard treatment method for early gastric cancers (EGCs) due to the negligible risk for lymph node metastasis (LNM) in Eastern Asian countries. According to the guidelines, the curability of EGC after endoscopic resection was classified into three groups: curative resection, expanded curative resection, and noncurative resection. In Eastern Asian countries, a structured follow-up schedule is needed for patients undergoing curative resection and expanded curative resection. Conversely, in Western countries, additional surgery may be recommended for some patients undergoing expanded curative resection (ulcerated, undifferentiated, or slight submucosal invasion) due to the potential risk for LNM, even though specimens of ESD and surgery may not be handled with the same methodology as that used in Japan, which may lead to this slightly higher risk. In noncurative resection, additional surgery is the standard method after ESD because of the risk for LNM. However, in elderly patients and/or those with severe underlying diseases, the advantages and disadvantages of additional surgery should be considered when selecting a post-ESD treatment strategy for patients undergoing noncurative resection. Risk-scoring systems for LNM may facilitate clinical decisions for these patients. However, it should be noted that when recurrence was detected in patients who were followed up with no additional treatment after ESD with noncurative resection, most of them had a poor prognosis. To select an appropriate treatment method, especially in elderly patients undergoing ESD with noncurative resection, a new tool for evaluating the condition of patients should be established. (Gut Liver 2020;14:412-422 ) This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

show abstract

Long-term outcomes and prognostic factors with non-curative endoscopic submucosal dissection for gastric cancer in elderly patients aged ≥ 75 years

Cited by 49 publications

References 35 publications

Relationship between markers of malnutrition and clinical outcomes in older adults with cancer: systematic review, narrative synthesis and meta-analysis

Relationship between markers of malnutrition and clinical outcomes in older adults with cancer: systematic review, narrative synthesis and meta-analysis

Management following endoscopic resection in elderly patients with early‐stage upper gastrointestinal neoplasia

A Recent Argument for the Use of Endoscopic Submucosal Dissection for Early Gastric Cancers

Contact Info

Product

Resources

About