Characteristics and prognosis of gastric cancer in patients aged ≥ 70 years

Abstract

Aim: To elucidate the prognostic value of age for gastric cancer and identify the optimal treatment for elderly gastric cancer patients.

Methods: We enrolled 920 patients with gastric cancer who underwent gastrectomy between January 2003 and December 2007 in our center. Patients were categorized into three groups: younger group (age < 50 years), middle-aged group (50-69 years), and elderly group (≥ 70 years). Clinicopathological features were compared among the three groups and potential prognostic factors were analyzed. The log-rank test was used to assess statistical differences between curves. Independent prognostic factors were identified by the Cox proportional hazards regression model. Stratified analysis was used to investigate the impact of age on survival at each stage. Cancer-specific survival was also compared among the three groups by excluding deaths due to reasons other than gastric cancer. We analyzed the potential prognostic factors for patients aged ≥ 70 years. Finally, the impact of extent of lymphadenectomy and postoperative chemotherapy on survival for each age group was evaluated.

Results: In the elderly group, there was a male predominance. At the same time, cancers of the upper third of the stomach, differentiated type, and less-invasive surgery were more common than in the younger or middle-aged groups. Elderly patients were more likely to have advanced tumor-node-metastasis (TNM) stage and larger tumors, but less likely to have distant metastasis. Although 5-year overall survival (OS) rate specific to gastric cancer was not significantly different among the three groups, elderly patients demonstrated a significantly lower 5-year OS rate than the younger and middle-aged patients (elderly vs middle-aged vs younger patients = 22.0% vs 36.6% vs 38.0%, respectively). In the TNM-stratified analysis, the differences in OS were only observed in patients with II and III tumors. In multivariate analysis, only surgical margin status, pT4, lymph node metastasis, M1 and sex were independent prognostic factors for elderly patients. The 5-year OS rate did not differ between elderly patients undergoing D1 and D2 lymph node resection, and these patients benefited little from chemotherapy.

Conclusion: Age ≥ 70 years was an independent prognostic factor for gastric cancer after gastrectomy. D1 resection is appropriate and postoperative chemotherapy is possibly unnecessary for elderly patients with gastric cancer.

Keywords: Chemotherapy; Elderly patients; Gastric carcinoma; Lymphadenectomy; Prognosis.

Figure 1

Overall survival curves for all patients grouped by age. Patients aged ≥ 70 years demonstrated a significantly lower 5-year OS rate than the younger and middle-aged patients (elderly vs middle-aged vs younger patients, 22.0% vs 36.6% vs 38.0%, respectively). EG: Elderly group; MG: Middle-aged group; YG: Younger group.

Figure 2

Overall survival curves for patients with tumor–node–metastasis II and III cancer. In the tumor-node-metastasis (TNM)-stratified analysis, the differences in overall survival (OS) were only observed in patients with TNM stage II and III cancer. A: Patients with II cancer; B: Patients with III cancer. EG: Elderly group; MG: Middle-aged group; YG: Younger group.

Figure 3

Cancer-specific survival of each age group. When deaths caused by factors other than gastric cancer were excluded, there were no significant differences in cancer-specific survival among the three age groups. EG: Elderly group; MG: Middle-aged group; YG: Younger group.

Figure 4

Overall survival curves for patients grouped by chemotherapy. In the age-stratified analysis, chemotherapy was a prognostic factor for the younger and middle-aged patients, but not for the elderly patients. A: All patients; B: Younger group; C: Middle-aged group; D: Elderly group.