Impact of Clinical and Pathohistological Characteristics on the Incidence of Recurrence and Survival in Elderly Patients with Gastric Cancer

• Published in: World journal of surgery Vol. 36; no. 2; pp. 338 - 345
• Main Authors: Dittmar, Yves, Rauchfuss, Falk, Götz, Max, Scheuerlein, Hubert, Jandt, Karin, Settmacher, Utz
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01-02-2012; Springer‐Verlag; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Age Factors; Aged; Aged, 80 and over; Antineoplastic Agents - therapeutic use; Cardiac Surgery; Chemotherapy, Adjuvant; Female; Follow-Up Studies; Gastrectomy; Gastric Cancer; Gastric Resection; General Surgery; Humans; Lymphatic Metastasis; Male; Medicine; Medicine & Public Health; Middle Aged; Multivisceral Resection; Neoplasm Recurrence, Local - epidemiology; Neoplasm Recurrence, Local - mortality; Neoplasm Staging; Positive Lymph Node; Retrospective Studies; Signet Ring Cell; Stomach Neoplasms - drug therapy; Stomach Neoplasms - mortality; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Surgery; Survival Analysis; Survival Rate; Thoracic Surgery; Treatment Outcome; Vascular Surgery; Gastric Cancer; Multivisceral Resection; Gastric Resection; Signet Ring Cell; Positive Lymph Node
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-011-1395-x

Background
Gastric cancer is one of the most frequent malignant tumors worldwide. Despite improvements in diagnostic procedures, as well as the introduction of multimodal treatment strategies, the overall prognosis remains poor. The role of gastric resection in elderly patients with gastric cancer has not been clearly defined as yet. The goal of the present study was to assess whether specific pathohistological features result in different outcomes for younger patients and elderly patients.
Methods
A total of 272 patients with advanced gastric cancer treated surgically in our hospital between 1998 and 2009 were included in the study. Data were analyzed from a prospectively maintained database.
Results
Median overall survival was 84 months in the younger subgroup and 37 months in the elderly subgroup (
P
 = 0.038), whereas local recurrence occurred more frequently in younger patients (33% vs. 23%). We identified positive lymph nodes at the contralateral curvature, perilymphonodular tumor cells, and positive lymph node conglomerates as strong negative prognostic factors. There were few pathohistological characteristics that affected survival and the incidence of tumor recurrence differently in elderly and younger patients. Although only a few elderly patients underwent chemotherapy plus gastric resection (7% vs. 28% of the younger patients), there was a trend toward longer survival for those who received multimodal treatment.
Conclusions
Our results suggest that there is no tumor-related prognostic difference between young and elderly patients that would preclude radical surgery in elderly patients, as long as they are generally fit for surgery.