Postoperative Long‐Term Outcomes in Elderly Patients with Gastric Cancer and Risk Factors for Death from Other Diseases

Hashimoto, Tadayoshi; Kurokawa, Yukinori; Mikami, Jota; Takahashi, Tsuyoshi; Miyazaki, Yasuhiro; Makino, Tomoki; Yamasaki, Makoto; Motoori, Masaaki; Kimura, Yutaka; Nakajima, Kiyokazu; Mori, Masaki; Doki, Yuichiro

doi:10.1007/s00268-019-05109-5

Cited by 34 publications

(33 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this study, the 5-year OS rate was significantly poor in the EP group. This result was similar with recent reports that elderly patients have poor physical or nutritional statuses and some degree of frailty, and are likely to die from other diseases even if gastric cancer can be cured by gastrectomy [16,17]. In this study, the 5-year DSS rate was significantly poor only in stage III EP group patients.…”

Section: Discussionsupporting

confidence: 92%

See 1 more Smart Citation

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

et al. 2021

View full text Add to dashboard Cite

Background This study was conducted to assess the long-term outcomes of elderly patients among propensity-score-matched gastric cancer patients after curative gastrectomy and to propose the proper management of elderly gastric cancer patients. Methods We enrolled 626 patients with gastric cancer who underwent curative gastrectomy at our institution between January 2004 and December 2015. To minimize selection bias among 2 groups, propensity score matching was performed. Results Patients were divided into an elderly group over 75 years old (EP group; n = 186) and a non-elderly group (NEP group; n = 440). After propensity score matching, patients were divided into EP group (n = 178) and NEP group (n = 175). Five-year overall survival was significantly lower in the EP group than in the NEP group, consistent with a subgroup analysis of each stage. However, the 5-year disease-specific survival among all enrolled patients and those with stage I and II disease did not differ significantly. Moreover, in the subgroup of stage III patients, 5 year disease-specific survival was significantly lower in the EP group (23.0%) than in the NEP group (59.4%; P = 0.004). Because elderly patients with stage III disease had an extremely poor prognosis, we decided to compare the two groups with stage III. The EP group contained significantly fewer patients with D2 lymphadectomy (P = 0.002) and adjuvant chemotherapy (P < 0.001) than the NEP group. C-reactive protein to albumin ratio was significantly higher in patients in the EP group than in the NEP group (P = 0.046), and the prognostic nutritional index was significantly lower in patients in the EP group than in the NEP group (P = 0.045).　Multivariate analysis revealed that the prognostic nutritional index and lymphatic invasion were independent prognostic factors. Conclusions Elderly gastric cancer patients with stage III disease showed poorer disease-specific survival compared with non-elderly patients, which may be due to a poorer nutritional and inflammatory background, fewer D2 lymphadenectomies, and a lack of adjuvant chemotherapy. The safe induction of standard lymphadenectomy and adjuvant chemotherapy with perioperative aggressive nutritional support may improve the prognosis of elderly gastric cancer patients with stage III disease.

show abstract

Section: Discussionsupporting

confidence: 92%

“…Propensity score matching was used to balance the two groups, but the results must be interpreted carefully. Second, there are various definitions of the elderly patient [16,29]. Currently, the Japanese Geriatrics Society has proposed to redefine the elderly as 75 years of age or older, and thus we adopted a threshold of 75 years [30].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

View full text Add to dashboard Cite

show abstract

“…In this study, the 5-year OS rate was signi cantly poor in the EP group. This result was similar with recent reports that elderly patients have poor physical or nutritional statuses and some degree of frailty, and are likely to die from other diseases even if gastric cancer can be cured by gastrectomy [14] [15]. In this study, the 5-year DSS rate was signi cantly poor only in stage III EP group patients.…”

Section: Discussionsupporting

confidence: 92%

“…Propensity score matching was used to balance the two groups, but the results must be interpreted carefully. Second, there are various de nitions of the elderly patient [14] [29]. Currently, the Japanese Geriatrics Society has proposed to rede ne the elderly as 75 years of age or older, and thus we adopted a threshold of 75 years [30].…”

Section: Discussionmentioning

confidence: 99%

Appraisal of Long-time Outcomes After Curative Surgery in Elderly Patients with Gastric Cancer: A Propensity Score Matching Analysis

Matunaga

Ishiguro

Miyauchi

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: This study was conducted to assess the long-term outcomes of elderly patients among propensity-score-matched gastric cancer patients after curative gastrectomy and to propose the proper management of elderly gastric cancer patients.Methods: We enrolled 626 patients with gastric cancer who underwent curative gastrectomy at our institution between January 2004 and December 2015. To minimize selection bias among 2 groups, propensity score matching was performed.Results: Patients were divided into an elderly group over 75 years old (EP group; n=186) and a non-elderly group (NEP group; n=440). After propensity score matching, patients were divided into EP group (n=186) and NEP group (n=186). Five-year overall survival was significantly lower in the EP group than in the NEP group, consistent with a subgroup analysis of each stage. However, the 5-year disease-specific survival among all enrolled patients and those with stage I and II disease did not differ significantly. Moreover, in the subgroup of stage III patients, 5-year disease-specific survival was significantly lower in the EP group (23.0%) than in the NEP group (59.4%; P=0.004). Because elderly patients with stage III disease had an extremely poor prognosis, we decided to compare the two groups with stage III. The EP group contained significantly fewer patients with D2 lymphadectomy (P=0.002) and adjuvant chemotherapy (P<0.001) than the NEP group. Multivariate analysis revealed that older age and lymphatic invasion were independent prognostic factors. C-reactive protein to albumin ratio was significantly higher in patients in the EP group than in the NEP group (P=0.046), and the prognostic nutritional index was significantly lower in EP group patients than NEP group patients (P=0.045). Conclusions: Elderly gastric cancer patients with stage III disease showed poorer disease-specific survival compared with non-elderly patients, which may be due to fewer D2 lymphadenectomies, a lack of adjuvant chemotherapy, and a poorer nutritional and inflammatory background. The safe induction of standard lymphadenectomy and adjuvant chemotherapy with perioperative aggressive nutritional support may improve the prognosis of elderly gastric cancer patients with stage III disease.

show abstract

“…However, GC treatment in the elderly faces several challenges, such as increased underlying comorbidities[ 10 ], low organ function, low immune function, and decreased willingness for treatment. Other problems that arise when surgery is performed are high postoperative complication rates and death from other diseases[ 11 ]. In addition, weight loss after gastrectomy significantly worsens quality of life and adversely affects the long-term prognosis of elderly patients with GC[ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Is surgery the best treatment for elderly gastric cancer patients?

Kawaguchi¹,

Akaike²,

Shoda³

et al. 2021

WJGS

View full text Add to dashboard Cite

As the elderly population increases, the number of patients with gastric cancer has also been increasing. Elderly people have various preoperative problems such as malnutrition, high frequency of comorbidities, decreased performance status, and dementia. Furthermore, when surgery is performed, high postoperative complication rates and death from other diseases are also concerns. The goal of surgery in the elderly is that short-term outcomes are comparable to those in nonelderly, and long-term outcomes reach life expectancy. Perioperative problems in the elderly include: (1) Poor perioperative nutritional status; (2) Postoperative pneumonia; and (3) Psychological problems (dementia and postoperative delirium). Malnutrition in the elderly has been reported to be associated with increased postoperative complications and dementia, pointing out the importance of nutritional management. In addition, multidisciplinary team efforts, including perioperative respiratory rehabilitation, preoperative oral care, and early postoperative mobilization programs, are effective in preventing postoperative pneumonia. Furthermore, there are many reports on the usefulness of laparoscopic surgery for the elderly, and we considered that minimally invasive surgery would be the optimal treatment after assessing preoperative risk.

show abstract

Postoperative Long‐Term Outcomes in Elderly Patients with Gastric Cancer and Risk Factors for Death from Other Diseases

Cited by 34 publications

References 44 publications

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

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

Appraisal of Long-time Outcomes After Curative Surgery in Elderly Patients with Gastric Cancer: A Propensity Score Matching Analysis

Is surgery the best treatment for elderly gastric cancer patients?

Contact Info

Product

Resources

About