Prognosis of gastric carcinoma patients aged 85 years or older who underwent surgery or who received best supportive care only

Endo, Shunji; Dousei, Tsutomu; Yoshikawa, Yukinobu; Hatanaka, Nobutaka; Kamiike, Wataru; Nishijima, Junichi

doi:10.1007/s10147-012-0482-9

Cited by 38 publications

(26 citation statements)

References 6 publications

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“…Endo et al [16] reported that the overall survival of elderly patients with gastric cancer who underwent surgery was significantly better than that of patients who received only best supportive care, especially among patients with resectable advanced gastric cancers. Therefore, surgical resection should be considered for elderly patients who can withstand it.…”

Section: Discussionmentioning

confidence: 99%

Impact of Gastric Cancer Surgery in Elderly Patients

Wakahara

Ueno²,

Maeda³

et al. 2017

Oncology

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Objectives: This study aimed to investigate the validity of gastric cancer surgery in elderly patients. Methods: A total of 544 patients who underwent elective gastrectomy for gastric cancer were divided into an elderly group (age ≥75 years, n = 171) and a control group (age <75 years, n = 373). The clinicopathological data of the patients were reviewed. Results: The overall morbidity rate (26.3 vs. 16.1%, p = 0.005) and the incidence rate of anastomotic leakage (6.4 vs. 1.6%, p = 0.003) were significantly higher in the elderly group. The proportion of patients who had severe complications (≥grade IIIa) was relatively higher in the elderly group (10.5 vs. 5.7%); however, the difference was not significant (p = 0.074). A stage-matched survival analysis revealed no significant differences between the groups (stage I: p = 0.978; stage II: p = 0.964; stage III: p = 0.199). For the pathological stages II and III, the overall survival of the patients in the elderly group who received adjuvant chemotherapy for >3 months was significantly better than that of the patients who received it for ≤3 months or did not receive it (p = 0.023). Conclusions: An aggressive treatment strategy should be adopted in selected elderly patients with gastric cancer.

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Section: Discussionmentioning

confidence: 99%

Impact of Gastric Cancer Surgery in Elderly Patients

Wakahara

Ueno²,

Maeda³

et al. 2017

Oncology

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“…This article concerning people aged 85 years or older is presented at a timely point. In this issue of the International Journal of Clinical Oncology, Dr. Endo report topics of the prognosis of gastric cancer patients aged 85 years and older, which reveal that females, patients aged 85-89 years, and patients with advanced cancer had better survival with surgery [1].…”

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confidence: 99%

Current status of treatment strategy for elderly patients with gastric cancer

Nashimoto

2012

Int J Clin Oncol

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The World Health Organization (WHO) has defined the chronological age of 65 or older as a definition of ''elderly'' or older person, and defined the former aged for people from 65 to 74 years, the latter aged for people from 75 to 84 years, and the super aged for people 85 years and more. In industrialized countries, life expectancy has increased consistently over the past decades. Life expectancy (male/ female) in Japan was 18.86/23.89 years for those 65 years old, 11.58/15.38 years for those 75 years old, and 6.18/ 8.30 years for those 85 years old by the complete life table in 2010, respectively. In Japan the population peaked in 2004 and has been decreasing recently. However, the number of people 65 years old and over is increasing continuously, being 23.0 % in 2010; further, 20 % of gastric cancer patients in Japan are more than 80 years old. According to the aging society, the current status of treatment strategy for elderly patients with gastric cancer is discussed.There is controversy regarding strategies for treating elderly patients with gastric cancer. The number of deaths of elderly patients with gastric cancer is increasing, but objective indicators for appropriate criteria of surgery and standard criteria of perioperative complications are not yet established. In the treatment algorithm of the NCCN guideline, there are items of ''medically fit'' and ''medically unfit,'' but no definite criteria. There are several prediction scoring systems for postoperative complications such as E-PASS, POSSUM Score, and so on. However, the published research is very limited because of the strict selection and underrepresentation of elderly patients in clinical trials.Elderly patients had significantly more co-morbidities and a poorer nutritional status than younger patients. The presence of co-morbidities was the independent factor affecting morbidity and mortality. In elderly patients, surgical strategies must be modulated on the basis of comorbidities, tumor stage, and future quality of life. It is important to control intraoperative bleeding and to avoid extensive lymph node dissection and combined resection of other organs. Extended lymph node dissection in elderly patients did not influence the 5-year survival rate, and the mortality and morbidity rates in extended lymph node dissection were higher than in limited dissection. Therefore, the surgical intervention had best be minimized. The decision whether to perform surgery for elderly patients should be made according to the individual physical and clinical condition such as favorable respiratory function, cardiac function, performance status, and general condition. Preoperative rehabilitation or training might be somewhat effective.The remote survival rate after curative gastrectomy of the elderly patients was lower than that of the younger patients because there were more non-cancer deaths. However, they also had a good prognosis whether or not other causes of death were considered. Recent improvements in the surgical techniques and perioperative managemen...

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“…Because of their peak incidence in the sixth and seventh decade in men and in the eighth and ninth decade in women [2], the absolute numbers and proportions of older patients with these cancers will increase with the expanding older population in industrial countries [3,4].…”

Section: Introductionmentioning

confidence: 99%

Age and Outcome in Gastrointestinal Cancers: A Population-Based Evaluation of Oesophageal, Gastric and Colorectal Cancer

et al. 2017

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Background: With demographic changes and partial representativeness of randomized studies the question arises which results are achieved in the treatment of the elderly. The objective was to analyse population-based data on gastrointestinal cancers in terms of age. Methods: Analyses included data of the Munich Cancer Registry, i.e. 4,014, 10,127 and 42,809 invasive oesophageal, gastric and colorectal cancer patients, respectively, which were diagnosed between 1998 and 2014. Tumour characteristics and outcome were analysed by age groups and therapy. Overall survival was analysed using the Kaplan-Meier method, and relative survival was computed as estimation for cancer-specific survival. Additionally, conditional survival of patients surviving at least 6 or 12 months was analysed by age. Results: 21, 44 and 38% of oesophageal, gastric and colorectal cancer patients, respectively, were aged >75 years. Of these, 15, 46 and 73% were surgically treated with curative intent, respectively, which is significantly less than in younger patients. The total 5-year relative survival was 24, 33 and 66%, respectively. The differences in median survival by age group were diminished by selecting those surviving at least 6 or 12 months and those with curatively intended treatment. Conclusion: An adequate patient selection for therapies of these gastrointestinal cancers was demonstrated at large. If the patients' general conditions allowed curatively intended treatment, it was applied and led to similar outcomes irrespective of age.

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Prognosis of gastric carcinoma patients aged 85 years or older who underwent surgery or who received best supportive care only

Abstract: Females, patients aged 85-89 years, and patients with stage IB-IIIC cancer had significantly better OS with surgery than without. For males, patients aged ≥90 years, or stage IA patients, the decision to perform surgery should be carefully made, and BSC might be an optimal strategy.

Cited by 38 publications

References 6 publications

Impact of Gastric Cancer Surgery in Elderly Patients

Impact of Gastric Cancer Surgery in Elderly Patients

Current status of treatment strategy for elderly patients with gastric cancer

Age and Outcome in Gastrointestinal Cancers: A Population-Based Evaluation of Oesophageal, Gastric and Colorectal Cancer

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