Clinicopathological Features and Prognosis in Elderly Gastric Cancer Patients: A Retrospective Cohort Study

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the ONA take:

Elderly patients with gastric cancer have clinicopathologic features distinct from younger patients, as well as significantly worse prognoses.

Data regarding the clinicopathologic features and prognoses of older patients compared with those of middle-aged patients have been a point of controversy. Recent studies have produced conflicting evidence, some indicating that elderly patients are more commonly associated with poorly differentiated tumors and have worse prognoses, and vice versa for younger patients according to other studies. Further investigation is required.

For this retrospective study, investigators enrolled 5285 patients with gastric cancer who underwent curative surgical resection. Patients were divided into elderly and middle-aged cohorts to identify disease features (eg, dysphagia, abdominal pain, heartburn) that were more characteristic to either study arm; survival outcomes were assessed as well.

The authors present their analysis regarding survival outcomes and clinicopathologic features.

OncoTargets and Therapy
OncoTargets and Therapy

Background: Little is known about the clinicopathological features and prognosis in elderly gastric cancer (GC) patients aged 65–79 years. The aim of this study was to evaluate clinicopathological features and prognosis in elderly GC patients.
Patients and methods: From May 2008 to December 2014, a total of 5,282 GC patients were enrolled in our present study. Patients were divided into elderly and middle-aged groups. The clinicopathological features and clinical outcomes were analyzed.
Results:
The proportion of dysphagia was significantly higher in elderly patients than that in middle-aged patients (P=0.002), whereas the proportion of abdominal pain and heartburn was significantly lower in elderly patients than that in middle-aged patients (P<0.001 vs P=0.038, respectively). The proportion of patients with carbohydrate antigen (CA) 19-9 was significantly higher in elderly patients than that in middle-aged patients (P=0.009). There was no significant difference in clinicopathological features between elderly and middle-aged patients with D2 gastrectomy (all P>0.05). Age, tumor size, histological type, tumor depth, lymph node metastasis, carcinoembryonic antigen, alpha fetoprotein, CA19-9, and CA125 were independent risk factors for the prognosis of GC patients in univariate and multivariate analyses. Overall survival in elderly patients was significantly reduced compared with middle-aged patients (P=0.001), especially in patients with tumor size >5 cm (P=0.002), poorly differentiated tumor (P<0.000), stage III tumor (P=0.002), or normal levels of carcinoembryonic antigen (P=0.009), alpha fetoprotein (P=0.002), CA19-9 (P=0.002), and CA125 (P=0.004).
Conclusion: The clinicopathological features of elderly patients were different to those of middle-aged patients. The prognosis for elderly GC patients was significantly worse than for middle-aged patients.


Keywords: gastric cancer, elderly, clinicopathological features, prognosis 

BACKGROUND

As the world's population ages, gastric cancer (GC) has become a very common cancer in elderly patients,1,2 especially in patients aged 65 years and older.3,4 Data on the clinicopathological features and prognosis of elderly GC patients are limited and controversial. It was indicated that poorly differentiated tumors were more common in elderly patients.5 However, some studies indicated that younger patients exhibited a predominance of poorly differentiated tumor.6,7 Furthermore, it was reported that the prognosis of GC in the elderly was worse than that in nonelderly patients because of the aggressive biological behavior and poorly differentiated histology of the tumor.8,9 However, Zeeneldin et al10 reported that the prognosis in elderly patients is equivalent to or better than that in nonelderly patients. Moreover, few studies have focused specifically on the clinicopathological features and prognosis of GC in elderly and middle-aged patients.

Against this background, we retrospectively analyzed the clinicopathological features and prognosis of elderly and middle-aged GC patients with curative surgical resection. The aim of this study was to identify the clinicopathological features and prognosis of GC in elderly patients. 

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