Prognosis of gastric carcinoma patients aged 85 years or older who underwent surgery or who received best supportive care only

Abstract

Background: There is controversy regarding strategies for treating very elderly patients with gastric carcinoma. We aimed to assess survival after surgery in very elderly patients according to their clinical characteristics.

Methods: Gastric cancer patients aged ≥85 years were retrospectively reviewed. There were no significant differences in clinical characteristics between 58 patients with curative resection (OP group) and 32 patients with best supportive care alone (BSC group) in cancer stage IA-IIIC and with a performance status of 0-3.

Results: Overall survival (OS) was significantly better in the OP group than in the BSC group in females [hazard ratio (HR) 0.27, 95 % confidence interval (CI) 0.12-0.57, P < 0.001] but not in males (HR 0.71, 95 % CI 0.35-1.49, P = 0.35). OS was significantly better in the OP group in patients aged 85-89 years (HR 0.44, 95 % CI 0.25-0.78, P = 0.006) but not in patients aged ≥90 years (HR 0.47, 95 % CI 0.12-1.66, P = 0.24). OS was significantly better in the OP group in patients with stage IB-IIIC cancer (HR 0.29, 95 % CI 0.14-0.58, P < 0.001) but not in patients with stage IA cancer (HR 0.52, 95 % CI 0.21-1.27, P = 0.15).

Conclusions: Females, patients aged 85-89 years, and patients with stage IB-IIIC cancer had significantly better OS with surgery than without. For males, patients aged ≥90 years, or stage IA patients, the decision to perform surgery should be carefully made, and BSC might be an optimal strategy.