Is it beneficial to perform surgical resection in elderly patients more than 80 years old with advanced gastric cancer?

Choo, Ji Yung; Ju, Yeonmi; Lim, Hyun; Youn, Sung Hee; Soh, Jae Seung; Park, Ji Won; Kang, Ho Suk; Kim, Sung Eun; Moon, Sung Hoon; Kim, Jong Hyeok; Park, Choong Kee; Ha, Hong Il; Kim, Minjeong; Kim, Kab-Choong; Cho, Ji Woong

doi:10.1080/00365521.2017.1339828

Cited by 13 publications

(9 citation statements)

References 19 publications

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“…5,14 In the present study, curative surgery showed significantly better overall survival compared to noncurative treatment and best supportive care despite the more advanced age. This result corresponded to a previous study by Choo et al 2 The better survival outcomes might be from unavoidable selection bias in choosing curative surgery for patients who tend to have a better performance status, relatively higher nutritional status, and the absence of clinical metastasis at the time of the treatment decision. Only four patients in our curative surgery group had a poor performance status, and none of them had severe postoperative complications.…”

Section: Discussionsupporting

confidence: 90%

“…From a recent study in elderly gastric cancer patients over 80 years old, curative resection showed a significant better overall survival compared to supportive care. 2,3 Those who received non-surgical care mostly died from gastric cancer. 3 Cancer-specific survival was 100% in clinical stage I. which can imply that this group died from non-cancer diseases.…”

Section: Introductionmentioning

confidence: 99%

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Retrospective Analysis of the Outcomes in Elderly Patients with Adenocarcinoma of the Stomach and Esophagogastric Junction Following Three Different Treatments

Methasate

2019

Smj

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Objective: To compare survival outcomes and complications in elderly patients who underwent three different treatments. Methods: The data of patients aged 70 years old or older diagnosed with adenocarcinoma of the stomach and esophagogastric junction (Siewert types II and III) between January 2005 and December 2016 were reviewed. The results of different treatments and risk factors for post-treatment morbidity and mortality were analyzed. Results: In total, 220 elderly patients were included: 102 (46.4%) who underwent curative intended gastrectomy with radical lymphadenectomy (Curative group), 62 (28.2%) who underwent non-curative surgery or endoscopy (Non-curative group), and 56 (25.4%) who received best supportive care (BSC group). Mean ages were 76.6, 78.1, and 78.7 years old, respectively (p=0.596). Median overall survival was 32, 5, and 3 months, respectively (p<0.001). In the curative group, overall survival was associated with the pathological stage (p=0.017), but not the resection category (p=0.298). Concerning the curative and non-curative groups, severe post-treatment complications occurred in 14 (8.5%) patients (7.8%, curative group; 9.7%, non-curative group). Severe post-treatment complication was associated with age ≥80 years (p=0.023) and coronary artery disease (p<0.001); however, multivariate analysis identified coronary artery disease as an independent risk factor for severe post-treatment complication. 5 (3%) patients had in-hospital mortality, associated with age ≥80 years old (p=0.039) and coronary artery disease (p=0.005). Conclusion: Curative and non-curative procedures can be safely performed in elderly patients. However, caution should be taken with extreme elderly patients, especially those with coronary artery disease. Best supportive care should be considered only for unfit patients.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Retrospective Analysis of the Outcomes in Elderly Patients with Adenocarcinoma of the Stomach and Esophagogastric Junction Following Three Different Treatments

Methasate

2019

Smj

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“…A previous study from our hospital compared the survival rates of the surgery group with those of the supportive-care group in elderly patents aged ≥ 80 years with advanced gastric cancer [20]. This study showed that patients aged 80-85 years could expect a better prognosis with surgical resection, and surgical resection in extremely elderly patients aged ≥ 85 years also tended to be associated good prognosis, although there was no statistical significance.…”

Section: Discussionmentioning

confidence: 82%

Clinical characteristics and prognosis of elderly patients with colorectal cancer: comparison between surgical resection and supportive care

Kim

Soh

et al. 2020

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Background Elderly colorectal cancer (CRC) patients tend to avoid standard treatment, especially curative surgical resection, because of concerns about surgical complications or underlying diseases. This study is intended to compare clinical characteristics and prognosis between patients who had undergone surgical resection and received supportive care, and to evaluate the usefulness of surgical treatment in elderly patients. Methods A total of 114 patients aged ≥80 years who were diagnosed with CRC were analyzed retrospectively. Of these patients, 73 patients underwent surgical resection for malignancy and 41 patients received supportive care. Clinicopathological factors and overall survival (OS) rates were compared. Results The s urgical resection group had better Eastern Cooperative Oncology Group (ECOG) performance status, American Society of Anesthesiologists (ASA) physical status, and a lower stage than did the supportive-care group. The 3-year OS rate of the surgical group was significantly higher than that of the supportive-care group (60.7% vs. 9.1%, p < 0.001). In extremely elderly patients (age ≥85 years), the surgical group showed a better 3-year OS rate than did the supportive-care group (73.9% vs. 6.3%, p < 0.001), although ECOG performance status and ASA physical status were not different. The post-operative mortality rate was 4.1%. In the analysis of risk factors related to survival, surgical resection was a good prognostic factor. Conclusions Surgical treatment in elderly CRC patients showed a survival benefit, even in the extremely elderly patients. Surgical resection for CRC in elderly patients can be considered to improve survival.

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“…They think that elderly patients should undergo operation because the bene t is the same as for young patients from short-term and long-term prognosis. On the other hand, Choo et al [27] found elderly patients aged 80-85 years could have a large bene t from the surgical resection and for elderly patients aged over 86 years, especially those with cardiovascular and renal system diseases, the risks and bene ts of the procedure should be weighed before surgery. Surgery and chemotherapy should be the recommended treatment strategy in elderly patients which can effectively improve patients' survival compared with conservative treatment [28].…”

Section: Performance In Risk Strati Cation Of Patientsmentioning

confidence: 99%

Development and Validation of a Prognostic Nomogram to Predict Overall Survival of Elderly Patients with Gastric Cancer

Zhou

Ding

Wang

et al. 2020

Preprint

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Background Gastric cancer (GC) is one of the most common malignant tumors of digestive tract origin in China. The proportion of elderly patients with gastric cancer (GC) gradually increases as the population ages. We aimed to develop a prognostic nomogram for prediction of elderly (≥ 75 years old) GC patients in overall survival (OS). Patients and Methods Patients with GC from 2005 to 2014 were selected from the Surveillance, Epidemiology, and End Result (SEER) database and randomly assigned to development and validation sets. The variables for establishing nomogram were confirmed by univariate and multivariate Cox proportional hazard analysis based on the development set. The predictive accuracy and discriminative ability of the model was evaluated using the receiver operating characteristic (ROC) curve, the concordance index (C-index) and calibration curves, while its clinical utility was assessed using decision curve analysis (DCA) and Kaplan-Meier curve. Results A total of 1445 patients were included in this study. The nomogram was developed including histologic grade, AJCC stage T, N, M and surgery according to the univariate and multivariate cox regression analysis, the area under the time-dependent receiver operating characteristic curve (AUC) and Occam’s Law of Razor. The C-index of the nomogram was higher than the TNM system in the training cohort (0.710 vs 0.652, p < 0.001), which was also confirmed in the validation cohort (0.701 vs 0.643, p < 0.001); and high AUCs were noted in both development and validation sets. The nomogram showed good discrimination and calibration in both development and validation sets. The DCA curves showed that the nomogram had better clinical utility compared to the AJCC stage model. In addition, participants could be divided into three disparate risk groups (low, moderate, high) by the nomogram. Conclusion This study established a prognostic nomogram that improved the performance of the AJCC staging system with incorporation of risk factors to better predict the short-term survival in elderly GC patients.

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Is it beneficial to perform surgical resection in elderly patients more than 80 years old with advanced gastric cancer?

Abstract: These results suggest that elderly patients aged 80-85 years with advanced gastric cancer could expect a better prognosis with surgical resection. However, extreme-elderly patients aged ≥86 years should consider the risks and benefits of surgical treatment.

Cited by 13 publications

References 19 publications

Retrospective Analysis of the Outcomes in Elderly Patients with Adenocarcinoma of the Stomach and Esophagogastric Junction Following Three Different Treatments

Retrospective Analysis of the Outcomes in Elderly Patients with Adenocarcinoma of the Stomach and Esophagogastric Junction Following Three Different Treatments

Clinical characteristics and prognosis of elderly patients with colorectal cancer: comparison between surgical resection and supportive care

Development and Validation of a Prognostic Nomogram to Predict Overall Survival of Elderly Patients with Gastric Cancer

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