Optimal treatment for Elderly Patients with Resectable Proximal Gastric Carcinoma: A Real World Study Based on National Cancer Database

Abstract

Background: High perioperative morbidity, mortality, and uncertain outcome of surgery in octogenarians with proximal gastric carcinoma (PGC) pose a dilemma for both patients and physicians. We aim to evaluate the risks and survival benefits of different strategies treated in this group. Methods: Octogenarians (≥80 years) with resectable proximal gastric carcinoma who were recommended for surgery were identified from National Cancer Database during 2004-2013. Results: Patients age ≥80 years with PGC were less likely to be recommended or eventually undergo surgery compared to younger patients. Patients with surgery had a significantly better survival than those without surgery (5-year OS: 26% vs. 7%, p<0.001), especially in early stage patients. However, additional chemotherapy (HR: 0.94, 95% CI: 0.82-1.08, P =0.36) or radiotherapy (HR: 0.97, 95% CI: 0.84-1.13, P =0.72) had limited benefits. On multivariate analysis, surgery (HR: 0.66, 95% CI: 0.51-0.86, P =0.002) was a significant independent prognostic factor, while extens ive surgery had no survival benefit (Combined organ resection: HR: 1.88, 95% CI: 1.22-2.91, P =0.004; number of lymph nodes examined: HR: 0.99, 95% CI: 0.97-1.00, P =0.10). Surgery performed at academic and research (AR) medical center had the best survival outcome (5-year OS: 30% in AR vs. 18%-27% in other programs, P <0.001) and lowest risk (30-day mortality: 1.5% in AR vs. 3.6%-6.6% in other programs, P <0.001; 90-day mortality: 6.2% in AR vs. 13.6%-16.4% in other programs, P <0.001) compared to other facilities. Conclusions: Less-invasive approach performed at academic and research medical center might be the optimal treatment for elderly patients aged ≥80 yrs with early stage resectable PGC.