Kotaro Sugawara1, Hiroharu Yamashita2, Sho Yajima2, Yukari Uemura3, Yasuhiro Okumura2, Masato Nishida2, Koichi Yagi2, Susumu Aikou2,4, Yasuyuki Seto2. 1. Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. kosugawara-tky@umin.ac.jp. 2. Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan. 3. Biostatistics Division, Clinical Research Support Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. 4. Department of Bariatric and Metabolic Care, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Abstract
PURPOSE: We aimed to evaluate the prognostic impact of pulmonary dysfunctions and their relationships with other possible prognostic factors, especially sarcopenia, in elderly patients with gastric carcinoma (GC). METHODS: In total, 402 elderly GC patients (≥ 75 years) who underwent radical gastrectomy were retrospectively reviewed. Restrictive and obstructive pulmonary dysfunction were defined as %VC < 80% and FEV1.0% < 70%, respectively. RESULTS: Forty-two patients (10.4%) had a low %VC, which was associated with ASA-PS, comorbidity and sarcopenia while correlating with neither the FEV1.0% nor pathological variables. The overall survival in the low %VC group was significantly worse than that in the high %VC group, especially in those with pStage I/II diseases. The survival was not stratified by FEV1.0%. Non-gastric cancer-related deaths were more prevalent in the low %VC group than in the high %VC group. The cancer-specific survival showed no significant differences between the two groups. A multivariate analysis revealed a low %VC to be the most powerful predictor of a poor survival among all independent variables, including sex, age, comorbidity, total gastrectomy, and pStage. Patients with both a low %VC and sarcopenia showed an extremely poor survival. CONCLUSIONS: Preoperative restrictive pulmonary dysfunction was independently associated with poor survival outcomes, especially when present in combination with sarcopenia, due to an increased risk of death from non-cancer-related causes.
PURPOSE: We aimed to evaluate the prognostic impact of pulmonary dysfunctions and their relationships with other possible prognostic factors, especially sarcopenia, in elderly patients with gastric carcinoma (GC). METHODS: In total, 402 elderly GCpatients (≥ 75 years) who underwent radical gastrectomy were retrospectively reviewed. Restrictive and obstructive pulmonary dysfunction were defined as %VC < 80% and FEV1.0% < 70%, respectively. RESULTS: Forty-two patients (10.4%) had a low %VC, which was associated with ASA-PS, comorbidity and sarcopenia while correlating with neither the FEV1.0% nor pathological variables. The overall survival in the low %VC group was significantly worse than that in the high %VC group, especially in those with pStage I/II diseases. The survival was not stratified by FEV1.0%. Non-gastric cancer-related deaths were more prevalent in the low %VC group than in the high %VC group. The cancer-specific survival showed no significant differences between the two groups. A multivariate analysis revealed a low %VC to be the most powerful predictor of a poor survival among all independent variables, including sex, age, comorbidity, total gastrectomy, and pStage. Patients with both a low %VC and sarcopenia showed an extremely poor survival. CONCLUSIONS: Preoperative restrictive pulmonary dysfunction was independently associated with poor survival outcomes, especially when present in combination with sarcopenia, due to an increased risk of death from non-cancer-related causes.