Original Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Oct 21, 2013; 19(39): 6568-6578
Published online Oct 21, 2013. doi: 10.3748/wjg.v19.i39.6568
Characteristics and prognosis of gastric cancer in patients aged ≥ 70 years
Yue-Xiang Liang, Jing-Yu Deng, Han-Han Guo, Xue-Wei Ding, Xiao-Na Wang, Bao-Gui Wang, Li Zhang, Han Liang
Yue-Xiang Liang, Jing-Yu Deng, Xue-Wei Ding, Xiao-Na Wang, Bao-Gui Wang, Li Zhang, Han Liang, Department of Gastric Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center of Cancer, Tianjin 300060, China
Han-Han Guo, Department of Cardiovascular Surgery, the First Hospital of Tianshui City, Tianshui 741000, Gansu Province, China
Author contributions: Liang YX, Liang H, Deng JY and Guo HH performed the majority of the study; Deng JY, Ding XW, Wang XN, Zhang L and Guo HH designed the study and analyzed data; Liang YX, Liang H, Wang BG and Guo HH wrote the manuscript; Deng JY, Ding XW, Wang BG and Wang XN revised the manuscript.
Supported by National Basic Research Program of China: 973 Program, No. 2010CB529301
Correspondence to: Han Liang, Professor, Department of Gastric Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy, National Clinical Research Center of Cancer, Huanhuxi Road, Hexi District, Tianjin 300060, China. tjlianghan@sohu.com
Telephone: +86-22-23340123 Fax: +86-22-23340123
Received: May 19, 2013
Revised: July 28, 2013
Accepted: August 4, 2013
Published online: October 21, 2013
Processing time: 172 Days and 20.7 Hours
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: Gastric carcinoma; Elderly patients; Prognosis; Lymphadenectomy; Chemotherapy

Core tip: Few studies have compared the characteristics and prognosis of gastric cancer among younger, middle-aged and elderly patients. Elderly patients have distinctive properties, and we have to treat them individually with particular care. We found that age ≥ 70 years was an independent prognostic factor for patients with gastric cancer after gastrectomy and these patients had distinctive characteristics of male predominance, larger tumor size, more histological differentiation, higher number of tumors located in the upper third of the stomach, and advanced tumor-node-metastasis stage, but less distant metastasis compared to younger and middle-aged patients.