Survival analysis of elderly patients over 65 years old with stage II/III gastric cancer treated with adjuvant chemotherapy after laparoscopic D2 gastrectomy: a retrospective cohort study

Abstract

Background The benefits of adjuvant chemotherapy for elderly patients with gastric cancer (GC) remain unknown because elderly patients are underrepresented in most clinical trials. This study aimed to evaluate the effectiveness and complications of adjuvant chemotherapy in patients > 65 years of age after laparoscopic D2 gastrectomy. Methods This was a single-center retrospective cohort study of elderly patients (> 65 years) with stage II/III GC who underwent curative laparoscopic D2 gastrectomy with R0 resection between 2004 and 2018. The adjuvant chemotherapy regimens included monotherapy (oral capecitabine) and doublet chemotherapy (oral capecitabine plus intravenous oxaliplatin [XELOX] or intravenous oxaliplatin, leucovorin, and 5-fluorouracil [FOLFOX]). The data were retrieved from a prospectively registered database maintained at the Department of General Surgery in Nanfang Hospital, China. The patients were divided as surgery alone and surgery plus adjuvant chemotherapy (chemo group). The overall survival (OS), disease-free survival (DFS), chemotherapy duration, and toxicity were examined. Results There were 270 patients included: 169 and 101 in the surgery and chemo groups, respectively. There were 10 (10/101) and six (6/101) patients with grade 3+ non-hematological and hematological adverse events. The 1−/3−/5-year OS rates of the surgery group were 72.9%/51.8%/48.3%, compared with 90.1%/66.4%/48.6% for the chemo group (log-rank test: P = 0.018). For stage III patients, the 1−/3−/5-year OS rates of the surgery group were 83.7%/40.7%/28.7%, compared with 89.9%/61.2%/43.6% for the chemo group (log-rank test: P = 0.015). Adjuvant chemotherapy was significantly associated with higher OS (HR = 0.568, 95%CI: 0.357–0.903, P = 0.017) and DFS (HR = 0.511, 95%CI: 0.322–0.811, P = 0.004) in stage III patients. Conclusions This study suggested that adjuvant chemotherapy significantly improves OS and DFS compared with surgery alone in elderly patients with stage III GC after D2 laparoscopic gastrectomy, with a tolerable adverse event profile.

No long-term survival benefit with sustained-release 5-fluorouracil implants in patients with stages II and III gastric cancer

“…In the present study, the use of sustained-release 5-FU implants did not improve the long-term survival of gastric cancer patients with either TNM stage II or III. The estimated 5-year survival of patients with gastric cancer with TNM stage III in SR and NSR group was 50% and 49%, respectively ( P = 0.775), slightly higher than that of previous studies[ 31 , 32 ]. This may have been due to the R0 radical resection decreasing the risk of local-regional recurrence and compromising the effects of the sustained-release drug.…”

Elderly patients with stage II gastric cancer do not benefit from adjuvant chemotherapy

“…Previous reports have still shown controversy about the efficacy and safety of adjuvant chemotherapy in stage II GC patients, even though recommended in clinical guidelines [ 10 , 11 ]. Similarly, the abovementioned analyses showed divergences in the prognostic significance of chemotherapy.…”

“…It was noteworthy to note that no standard definition of EGC exists. Previous researchers used artificial cutoff points to divide cases into groups (like 60 [ 10 , 17 ], 70 [ 18 , 19 ], 75 [ 20 , 21 ], and 80 [ 22 , 23 ] years old), then evaluated survival differences between the groups. Here, we performed the KAPS method to determine the most appropriate age partition value to define the EGC group.…”

Duration of Perioperative Chemotherapy in Locally Advanced Gastric Cancer: A “Less Is More” Question When ypN0 Is Achieved

“…Sometimes, clinicians lack enough evidence to say that the fixed regimens are optimal, although effective. More importantly, the real-world circumstances are often not as ideal as those in clinical trials (32). Patients may discontinue perioperative or adjuvant treatment due to various reasons, e.g., adverse events, low life quality, and financial burdens (33)(34)(35).…”