Predictors of early and late mortality after the treatment for early gastric cancers

Abstract

Objectives Although many patients with early gastric cancers (EGCs) die of non‐gastric cancer‐related causes, the association of the risk categories of lymph node metastasis (LNM) with all‐cause mortality remains unclear. We aimed to clarify the predictors of early and late mortality, separately. Methods Patients with endoscopic resection or gastrectomy for EGCs between 2003 and 2017 were retrospectively enrolled. We analyzed predictors for early and late mortality, including risk categories of LNM, treatment method, and nine non‐cancer‐related indices, separately, with a cut‐off value of 3 years. Results We enrolled 1439 patients with a median follow‐up period of 79 months. The 5‐year overall survival rate was 86.8%. In the multivariate Cox analysis, the most important predictors for early and late mortality were age ≥85 years (hazard ratio [HR] 2.88 and 4.54, respectively) and Eastern Cooperative Oncology Group Performance Status ≥2 (HR 3.00 and 4.19, respectively). Charlson comorbidity index ≥2 (HR 2.76 and 1.99, respectively), American Society of Anesthesiologists Physical Status ≥3 (HR 2.35 and 1.79, respectively), and C‐reactive protein/albumin ratio ≥0.028 (HR 2.30 and 1.58, respectively) were also predictors for both early and late mortality. Male (HR 2.26), intermediate‐ (HR 2.12)/high‐risk (HR 1.85) of LNM in eCura system, and sarcopenia evaluated by the psoas muscle mass index (HR 1.70) were predictors for early mortality. Conclusion The combined assessment of multiple predictors might help to predict early and/or late mortality in patients with EGCs. The eCura system was associated with early mortality.

Open and minimally invasive gastrectomy in Eastern and Western patient populations: A review of the literature and reasons for differences in outcomes

“…One study by Ogata et al 71 found that the most important predictors of early and late mortality following gastrectomy were age, Eastern…”

Endoscopic submucosal dissection as a less invasive option for elderly patients with early gastric cancer with a relative indication for endoscopic resection

“…This result can be interpreted as valid from the fact that in Japan, women have a longer life expectancy than men at same age 5 . Male sex has also been reported as a predictor of early mortality after ER for EGC 6 . Although there is a limitation due to the low number of events in women, the mortality was obviously higher in men (20.3% vs. 38.8%, respectively).…”

It is time to tailor endoscopic resection for early gastric cancer: Evaluate not only lesion but also patient

“…In this issue of Digestive Endoscopy , Ogata et al . analyzed all‐cause mortalities after ER or surgery and investigated the predictors of early and late mortality 7 . Multivariate analysis revealed that the most important predictor for early and late mortality was age ≥85 years.…”

“…Although both age ≥85 years and eCuraC‐2 (intermediate‐ and high‐risk LNM) were independent predictors of mortality, the hazard ratio (HR) was higher for patients aged ≥85 years (HR 2.88) than those for patients with eCuraC‐2, intermediate‐ and high‐risk LNM (HRs 2.12 and 1.85, respectively). Moreover, the HR was higher for patients with worse physical status indices than those for patients with eCuraC‐2, intermediate‐ and high‐risk LNM 7 . Thus, the treatment strategy can also be determined according to the patient’s comorbidities or physical status, since both gastric cancer‐related and unrelated causes contribute to mortality.…”

“…Moreover, the HR was higher for patients with worse physical status indices than those for patients with eCuraC-2, intermediate-and high-risk LNM. 7 Thus, the treatment strategy can also be determined according to the patient's comorbidities or physical status, since both gastric cancer-related and unrelated causes contribute to mortality. Furthermore, it is notable that eCuraC-2 with low-risk LNM was not an independent predictor of early or late mortality, even though this was a single-center retrospective study with a limited sample size.…”