Shunji Endo1, Yosuke Shimizu2, Masakazu Ikenaga3, Katsuya Ohta3, Terumasa Yamada3. 1. Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Higashiosaka, Japan. Electronic address: endo-s@higashiosaka-hosp.jp. 2. Department of Surgery, National Hospital Organization Kure Medical Center/Chugoku Cancer Center, Kure, Japan. 3. Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Higashiosaka, Japan.
Abstract
BACKGROUND: The purpose of this study was to compare the long-term outcomes of patients ≥85 years old with gastric cancer who underwent curative distal gastrectomy or best supportive care alone. METHODS: Among 241 consecutive patients aged ≥85 years who were diagnosed with gastric cancer, we retrospectively examined the cases of 56 patients that were treated with curative distal gastrectomy and 55 patients that were treated with best supportive care alone. To reduce selection bias, we conducted a propensity score-matching analysis. The patients' propensity scores were estimated using a logistic regression model based on the following variables: sex, age, clinical cancer stage, performance status score, and each item of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity score. Overall survival was compared using the Kaplan-Meier method and log-rank test. RESULTS: Thirty pairs of patients were generated via propensity score matching. The clinical characteristics of the 2 groups were well matched. The median overall survival time was 57.3 months after distal gastrectomy, while it was 16.0 months after best supportive care (P = .0002). Subgroup analyses of each sex showed that in males there was no significant difference in overall survival between distal gastrectomy and best supportive care (P = .37) while the overall survival of females was significantly better after distal gastrectomy than after best supportive care (P < .0001). CONCLUSION: Our propensity score-matched study suggested that distal gastrectomy results in significantly better long-term survival than best supportive care alone in female patients with gastric cancer aged ≥85 years. In males, the indications for operation should be carefully determined.
BACKGROUND: The purpose of this study was to compare the long-term outcomes of patients ≥85 years old with gastric cancer who underwent curative distal gastrectomy or best supportive care alone. METHODS: Among 241 consecutive patients aged ≥85 years who were diagnosed with gastric cancer, we retrospectively examined the cases of 56 patients that were treated with curative distal gastrectomy and 55 patients that were treated with best supportive care alone. To reduce selection bias, we conducted a propensity score-matching analysis. The patients' propensity scores were estimated using a logistic regression model based on the following variables: sex, age, clinical cancer stage, performance status score, and each item of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity score. Overall survival was compared using the Kaplan-Meier method and log-rank test. RESULTS: Thirty pairs of patients were generated via propensity score matching. The clinical characteristics of the 2 groups were well matched. The median overall survival time was 57.3 months after distal gastrectomy, while it was 16.0 months after best supportive care (P = .0002). Subgroup analyses of each sex showed that in males there was no significant difference in overall survival between distal gastrectomy and best supportive care (P = .37) while the overall survival of females was significantly better after distal gastrectomy than after best supportive care (P < .0001). CONCLUSION: Our propensity score-matched study suggested that distal gastrectomy results in significantly better long-term survival than best supportive care alone in female patients with gastric cancer aged ≥85 years. In males, the indications for operation should be carefully determined.