See the published version of this preprint at BMC Surgery.
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Research article
Tomoyuki Matunaga
Tottori University Hospital: Tottori Daigaku Igakubu Fuzoku Byoin
Corresponding Author
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Background: This study was conducted to assess the long-term outcomes of elderly patients among propensity-score-matched gastric cancer patients after curative gastrectomy and to propose the proper management of elderly gastric cancer patients.
Methods: We enrolled 626 patients with gastric cancer who underwent curative gastrectomy at our institution between January 2004 and December 2015. To minimize selection bias among 2 groups, propensity score matching was performed.
Results: Patients were divided into an elderly group over 75 years old (EP group; n=186) and a non-elderly group (NEP group; n=440). After propensity score matching, patients were divided into EP group (n=186) and NEP group (n=186). Five-year overall survival was significantly lower in the EP group than in the NEP group, consistent with a subgroup analysis of each stage. However, the 5-year disease-specific survival among all enrolled patients and those with stage I and II disease did not differ significantly. Moreover, in the subgroup of stage III patients, 5-year disease-specific survival was significantly lower in the EP group (23.0%) than in the NEP group (59.4%; P=0.004). Because elderly patients with stage III disease had an extremely poor prognosis, we decided to compare the two groups with stage III. The EP group contained significantly fewer patients with D2 lymphadectomy (P=0.002) and adjuvant chemotherapy (P<0.001) than the NEP group. Multivariate analysis revealed that older age and lymphatic invasion were independent prognostic factors. C-reactive protein to albumin ratio was significantly higher in patients in the EP group than in the NEP group (P=0.046), and the prognostic nutritional index was significantly lower in EP group patients than NEP group patients (P=0.045).
Conclusions: Elderly gastric cancer patients with stage III disease showed poorer disease-specific survival compared with non-elderly patients, which may be due to fewer D2 lymphadenectomies, a lack of adjuvant chemotherapy, and a poorer nutritional and inflammatory background. The safe induction of standard lymphadenectomy and adjuvant chemotherapy with perioperative aggressive nutritional support may improve the prognosis of elderly gastric cancer patients with stage III disease.
Keywords
elderly patient, gastric cancer, prognosis
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View the published article at BMC Surgery.
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Posted 23 Dec, 2020
Review #2 received
Received 23 Dec, 2020
Reviewer #3 agreed
On 05 Dec, 2020
Review #1 received
Received 03 Dec, 2020
Reviewer #2 agreed
On 02 Dec, 2020
Editor assigned
On 02 Dec, 2020
Reviewers invited
Invitations sent on 02 Dec, 2020
Reviewer #1 agreed
On 02 Dec, 2020
Submission checks complete
On 02 Dec, 2020
Editor invited
On 02 Dec, 2020
This version was not preprinted
Version 1
Posted 24 Sep, 2020
No community comments so far
Editorial decision: Major revision
On 20 Nov, 2020
Review #3 received
Received 19 Nov, 2020
Reviewer #3 agreed
On 02 Nov, 2020
Review #2 received
Received 28 Oct, 2020
Review #1 received
Received 15 Oct, 2020
Reviewer #2 agreed
On 07 Oct, 2020
Reviewer #1 agreed
On 04 Oct, 2020
Reviewers invited
Invitations sent on 25 Sep, 2020
Editor assigned
On 14 Sep, 2020
Submission checks complete
On 13 Sep, 2020
Editor invited
On 13 Sep, 2020
First submitted
On 10 Sep, 2020
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See the published version of this preprint at BMC Surgery.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Tomoyuki Matunaga
Tottori University Hospital: Tottori Daigaku Igakubu Fuzoku Byoin
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at BMC Surgery.
Version (no preprint)
Posted 23 Dec, 2020
Review #2 received
Received 23 Dec, 2020
Reviewer #3 agreed
On 05 Dec, 2020
Review #1 received
Received 03 Dec, 2020
Reviewer #2 agreed
On 02 Dec, 2020
Editor assigned
On 02 Dec, 2020
Reviewers invited
Invitations sent on 02 Dec, 2020
Reviewer #1 agreed
On 02 Dec, 2020
Submission checks complete
On 02 Dec, 2020
Editor invited
On 02 Dec, 2020
This version was not preprinted
Version 1
Posted 24 Sep, 2020
No community comments so far
Editorial decision: Major revision
On 20 Nov, 2020
Review #3 received
Received 19 Nov, 2020
Reviewer #3 agreed
On 02 Nov, 2020
Review #2 received
Received 28 Oct, 2020
Review #1 received
Received 15 Oct, 2020
Reviewer #2 agreed
On 07 Oct, 2020
Reviewer #1 agreed
On 04 Oct, 2020
Reviewers invited
Invitations sent on 25 Sep, 2020
Editor assigned
On 14 Sep, 2020
Submission checks complete
On 13 Sep, 2020
Editor invited
On 13 Sep, 2020
First submitted
On 10 Sep, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at BMC Surgery.
Background: This study was conducted to assess the long-term outcomes of elderly patients among propensity-score-matched gastric cancer patients after curative gastrectomy and to propose the proper management of elderly gastric cancer patients.
Methods: We enrolled 626 patients with gastric cancer who underwent curative gastrectomy at our institution between January 2004 and December 2015. To minimize selection bias among 2 groups, propensity score matching was performed.
Results: Patients were divided into an elderly group over 75 years old (EP group; n=186) and a non-elderly group (NEP group; n=440). After propensity score matching, patients were divided into EP group (n=186) and NEP group (n=186). Five-year overall survival was significantly lower in the EP group than in the NEP group, consistent with a subgroup analysis of each stage. However, the 5-year disease-specific survival among all enrolled patients and those with stage I and II disease did not differ significantly. Moreover, in the subgroup of stage III patients, 5-year disease-specific survival was significantly lower in the EP group (23.0%) than in the NEP group (59.4%; P=0.004). Because elderly patients with stage III disease had an extremely poor prognosis, we decided to compare the two groups with stage III. The EP group contained significantly fewer patients with D2 lymphadectomy (P=0.002) and adjuvant chemotherapy (P<0.001) than the NEP group. Multivariate analysis revealed that older age and lymphatic invasion were independent prognostic factors. C-reactive protein to albumin ratio was significantly higher in patients in the EP group than in the NEP group (P=0.046), and the prognostic nutritional index was significantly lower in EP group patients than NEP group patients (P=0.045).
Conclusions: Elderly gastric cancer patients with stage III disease showed poorer disease-specific survival compared with non-elderly patients, which may be due to fewer D2 lymphadenectomies, a lack of adjuvant chemotherapy, and a poorer nutritional and inflammatory background. The safe induction of standard lymphadenectomy and adjuvant chemotherapy with perioperative aggressive nutritional support may improve the prognosis of elderly gastric cancer patients with stage III disease.
Figure 1
Figure 2
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