The recommended treatment strategy for locally advanced gastric cancer in elderly patients aged 75 years and older: a Surveillance, Epidemiology, and End Results database analysis

Abstract

Background: As patients aged 75 years and older are often underrepresented in randomized clinical trials, the external validity of clinical trials-based recommendations in older gastric patients was still controversial. The aim of this study is to explore the recommended treatment strategy for locally advanced gastric cancer in elderly patients.

Methods: We designed our study to specifically evaluate the cancer-specific survival (CSS) of four subgroups of patients according to four different treatment modalities: adjuvant radiation (RT), surgery only, RT only and no surgery/no RT by analyzing the Surveillance, Epidemiology, and End Results (SEER)-registered database. Kaplan-Meier methods were adopted and multivariable Cox regression models were built for the analysis of survival outcomes and risk factors.

Results: The 5-year CSS was 43.8 % in adjuvant RT, 28.5 % in surgery only, 14.9 % in RT only and 1.4 % in no surgery/no RT, which had significant difference in univariate log-rank test (P < 0.001) and multivariate Cox regression (P < 0.001). Moreover, we observed significant survival benefits in adjuvant RT group in all age categories, including age 75-79 years, age 80-84 years and age ≥85 years (all P < 0.001).

Conclusions: Surgery and adjuvant RT may be the recommended treatment strategy in elderly patients with locally advanced gastric cancer, especially for patients medically fit for the combined modality therapy.

Keywords: Elderly; Gastric cancer; SEER; Treatment.

Fig. 1

Trend of the proportion of patients with gastric cancer aged 75 years and older from 2004 to 2011

Fig. 2

Patterns of care are illustrated for elderly patients (≥75) with locally advanced gastric cancer from 2004 to 2011 according to treatment modality. RT indicates radiation

Fig. 3

Patterns of care are illustrated for patients (<75) with locally advanced gastric cancer from 2004 to 2011 according to treatment modality. RT indicates radiation

Fig. 4

Survival curves in elderly patients with gastric cancer according to four subgroups. The 5-year cancer-specific survival was 43.8 % in adjuvant RT, 28.5 % in surgery only, 14.9 % in RT only and 1.4 % in no surgery/no RT, which had significant difference (P < 0.001). RT indicates radiation

Fig. 5

Survival curves in patients with gastric cancer according to four subgroups in age 75–79 years (P < 0.001). RT indicates radiation

Fig. 6

Survival curves in patients with gastric cancer according to four subgroups in age 80–84 years (P < 0.001). RT indicates radiation

Fig. 7

Survival curves in patients with gastric cancer according to four subgroups in age ≥85 years (P < 0.001). RT indicates radiation