Korean J Gastroenterol.  2011 Jul;58(1):9-19. 10.4166/kjg.2011.58.1.9.

Clinicopathological Characteristics of Gastric Cancer and Survival Improvement by Surgical Treatment in the Elderly

• Choi JY
• Shim KN
• Roh SH
• Tae CH
• Kim SE
• Jung HK
• Kim TH
• Jung SA
• Yoo K
• Moon IW

• KMID: 1792809
• DOI: http://doi.org/10.4166/kjg.2011.58.1.9

Abstract

BACKGROUND/AIMS
It has been known that elderly patients with gastric cancer show worse general condition and higher comorbidities. Therefore, few elderly patients undergo surgery. This study was designed to determine clinicopathological characteristics of gastric cancer in elderly patients and evaluate their survival improvements by the surgical treatment.
METHODS
Gastric cancer patients, diagnosed at Ewha Womans University Mokdong Hospital between 2000 to 2004, were divided into two groups those aged > or =65 years vs. <65 years. Clinicopathological characteristics, incidence of postoperative complications, and survival time of patients in each group were analyzed.
RESULTS
Total 370 patients were subjected and divided into the elderly and the younger group (55.4% vs. 44.6%). The elderly group showed higher incidences of hypertension and cardiovascular disease. Well differentiated adenocarcinoma was more frequently found in the elderly group (19.0% vs. 10.0%, p=0.025). There were no differences of operation time (242.6+/-70.7 vs. 257.3+/-83.8 min, p=0.115), postoperative hospital stays (15.8+/-10.6 vs. 14.7+/-9.8 days, p=0.361), and incidence of any complications (6.7% vs. 9.9%, p=0.309) between the two subgroups. The significant factors related with the elderly patient's survival were the tumor-node-metastasis (TNM) stage (stage I, hazard ratio [HR] 1.00; stage II, HR 1.28, 95% confidence interval [CI] 0.44-3.72; stage III, HR 4.06, 95% CI 2.08-7.92, stage IV, HR 9.78, 95% CI 4.97-19.26;p<0.001) and the treatment modality (laparoscopy, HR 1.00; open surgery, HR 3.90, 95% CI 2.43-6.26;p<0.001). The elderly patients who underwent gastric cancer surgery showed prolonged survival on TNM stage I, II, and III than those who were treated conservatively.
CONCLUSIONS
In the elderly patients with gastric cancer, those who had received surgical treatments showed significantly higher survival rate than those who had treated conservatively. Therefore, aggressive surgical treatments should be seriously considered even for the elderly patients with gastric cancer.

Keyword

Aged; Elderly; Gastric cancer; Surgery

MeSH Terms

Adenocarcinoma/mortality/*pathology/surgery
Adult
Aged, 80 and over
*Aging
Carcinoembryonic Antigen/analysis
Cardiovascular Diseases/complications/epidemiology
Female
Humans
Hypertension/complications/epidemiology
Kaplan-Meier Estimate
Length of Stay
Male
Middle Aged
Neoplasm Metastasis
Neoplasm Staging
Retrospective Studies
Stomach Neoplasms/mortality/*pathology/surgery

Figure

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  Fig. 1. Age distribution of the patients and difference of treatment modality according to age distribution.

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  Fig. 2. Kaplan-Meier overall survival curves for the younger group (age<65) and older group (age ≥65) according to the each stage of gastric cancer in surgery group. The cumulative survival rate of the older group (stippled line) was not significantly different from that of the younger group (solid line) in each stage (A; stage I, B; stage II, C; stage III, D; stage VI).

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  Fig. 3. Kaplan-Meier overall survival curves for the surgery group and conservative group for each stage of gastric cancer in the older (age≥65), stage I (A), II (B), III (C), and IV (D). The cumulative survival rate of the surgery group (solid line) was significantly better than that of the conservative group (stippled line) in the stage I, II, and III, but not in stage IV.

Reference

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