Clinicopathological Features and Surgical Safety of Gastric Cancer in Elderly Patients

Abstract

Gastric cancer is one of the most common cancers, especially among the elderly. However little is known about gastric cancer in elderly patients. This study was designed to evaluate the specific features of gastric cancer in elderly patients. Medical records of 1,107 patients who had radical gastrectomy for gastric cancer between June 2005 and December 2009 were reviewed. They were divided into young (<65 yr, n=676), young-old (65-74 yr, n=332), and old-old age group (≥75 yr, n=99). Increased CA 19-9 (5.6%, 13.4%, 14.6%, P=0.001), advanced diseases (42.5%, 47.0%, and 57.6, P=0.014), and node metastasis (37.6%, 38.9%, 51.5%, P=0.029) were more common in the young-old and old-old age groups. There were no significant differences in Helicobacter pylori status (63.6%, 56.7%, 61.2%, P=0.324) between the three groups. Surgery-related complication rates were similar in the three groups (5.3%, 5.1%, 8.1%, P=0.497). Microsatellite instability (P<0.001) and p53 overexpression (P<0.001) were more common among the elderly. The elderly group had more synchronous tumors (7.5%, 10.2%, 17.2%; P=0.006). Surgery can be applied to elderly gastric cancer without significant risk of complications. However, considering the more advanced disease and synchronous tumors among the elderly, care should be taken while deciding the extent of surgery for elderly gastric cancer.Graphical Abstract

Lymphadenectomy in elderly/high risk patients: should it be different?

“…Regarding lymph node involvement, if several reports did not show any significant difference in the rate of lymph node involvement (10,(28)(29)(30), other authors described a trend toward higher incidence of lymph node involvement in the elderly, although statistical significance was not reached (8,31); conversely in cases of early disease, several studies report lower prevalence of lymph node metastases in the elderly as compared to patients aged under 75 (7,27).…”

“…Lim reported a higher rate of comorbidities in the elderly, with a significant increase in the number of comorbidities with aging (8), underlining the frailty of this population. Nonetheless, aging is an individualized process, bringing both physiologic and psychosocial changes that can affect tumor biology, decision-making and tolerance for cancer treatment, and ultimately outcomes (18).…”

“…Actually, the prognostic significance of age in gastric cancer is not clearly defined: in literature data are generally limited, and mostly discordant (7,8). Moreover, it is important to underline that overall survival (OS) in the elderly is clearly influenced by coexisting comorbidities.…”

“…Moreover, it is important to underline that overall survival (OS) in the elderly is clearly influenced by coexisting comorbidities. When disease-specific survival (DSS) is analyzed, it seems that prognosis in the elderly patients is not worse than in the control group (9)(10)(11), and even when it results to be worse, it is often a consequence of a more advanced disease at the time of diagnosis (8).…”

Clinical significance of prognostic score based on age, tumor size, and grade in gastric cancer after gastrectomy

“…The worse survival for the elderly might be explained partly by inadequate treatment. 18 A bad performance status cannot tolerate the extensive lymphadenectomy and standardized chemotherapy, 19 while young patients have a good performance status to quicker return of gastrointestinal function after surgery and to tolerate toxicities of standardized chemotherapy and comprehensive treatment. 18 , 20 …”