Yosuke Toya1, Tomohiro Shimada2, Koichi Hamada3, Ko Watanabe4, Jun Nakamura5, Daisuke Fukushi6, Waku Hatta7, Hirohiko Shinkai8, Hirotaka Ito9, Tamotsu Matsuhashi10, Shusei Fujimori11, Wataru Iwai12, Norihiro Hanabata13, Takeharu Shiroki14, Yu Sasaki15, Yuukou Fujishima16, Tsuyotoshi Tsuji17, Haruka Yorozu18, Tetsuro Yoshimura19, Yohei Horikawa20, Yasushi Takahashi21, Hiroshi Takahashi22, Yutaka Kondo23, Takao Fujiwara24, Hisata Mizugai25, Takahiro Gonai26, Tetsuya Tatsuta27, Kengo Onochi28, Norihiko Kudara29, Keinosuke Abe30, Tetsuya Ohira2, Yoshinori Horikawa31, Ryoichi Ishihata4, Takuto Hikichi5, Kennichi Satoh6, Fumiaki Takahashi32, Atsushi Masamune7, Katsunori Iijima10, Shinsaku Fukuda27, Takayuki Matsumoto33. 1. Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Idaidori 1-1-1, Yahaba, 028-3694, Japan. ytoya@iwate-med.ac.jp. 2. Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan. 3. Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan. 4. Department of Gastroenterology, Ohara General Hospital, Fukushima, Japan. 5. Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan. 6. Division of Gastroenterology, Tohoku Medical and Pharmaceutical University, Sendai, Japan. 7. Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan. 8. Department of Gastroenterology, Iwate Prefectural Isawa Hospital, Oshu, Japan. 9. Department of Gastroenterology, Osaki Citizen Hospital, Osaki, Japan. 10. Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan. 11. Department of Gastroenterology, Yokote Municipal Hospital, Yokote, Japan. 12. Department of Gastroenterology, Miyagi Cancer Center, Natori, Japan. 13. Division of Endoscopy, Aomori Prefectural Central Hospital, Aomori, Japan. 14. Department of Gastroenterology, Iwate Prefectural Central Hospital, Morioka, Japan. 15. Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata, Japan. 16. Division of Gastroenterology, Noshiro Kosei Medical Center, Noshiro, Japan. 17. Department of Gastroenterology, Akita City Hospital, Akita, Japan. 18. Digestive Disease Center, Akita Red Cross Hospital, Akita, Japan. 19. Division of Gastroenterology, Aomori City Hospital, Aomori, Japan. 20. Department of Gastroenterology, Hiraka General Hospital, Yokote, Japan. 21. Department of Gastroenterology, National Hospital Organization Sendai Medical Center, Sendai, Japan. 22. Department of Gastroenterology, Iwate Prefectural Ninohe Hospital, Ninohe, Japan. 23. Division of Gastroenterology, Tohoku Rosai Hospital, Sendai, Japan. 24. Department of Gastroenterology, Japanese Red Cross Morioka Hospital, Morioka, Japan. 25. Department of Gastroenterology, Hachinohe Red Cross Hospital, Hachinohe, Japan. 26. Department of Gastroenterology, Iwate Prefectural Kuji Hospital, Kuji, Japan. 27. Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan. 28. Department of Gastroenterology, Omagari Kosei Medical Center, Daisen, Japan. 29. Department of Internal Medicine and Gastroenterology, Iwate Prefectural Ofunato Hospital, Ofunato, Japan. 30. Department of Gastroenterology, Iwate Prefectural Miyako Hospital, Miyako, Japan. 31. Department of Gastroenterology, Southern-Tohoku General Hospital, Fukushima, Japan. 32. Division of Medical Engineering, Department of Information Science, School of Medicine, Iwate Medical University, Yahaba, Japan. 33. Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Idaidori 1-1-1, Yahaba, 028-3694, Japan.
Abstract
PURPOSE: Little is known about the prognostic factors for survival after endoscopic submucosal dissection (ESD) in elderly patients with early gastric cancer (EGC). The aim of this study is to determine prognostic factors and a prediction model of 3-year survival after ESD for EGC in patients aged ≥ 85 years. METHODS: We retrospectively evaluated the clinical outcomes of 740 patients with EGC aged ≥ 85 years, who were treated by ESD at 30 institutions in Japan. Overall survival (OS) and disease-specific survival (DSS) were calculated with the Kaplan-Meier method. Prediction models for 3-year OS after ESD were estimated using the Cox proportional hazards model based on Uno's C-statistics. RESULTS: During the follow-up period, 309 patients died of any cause and 10 patients died of gastric cancer. OS and DSS after 3 years were 82.7% and 99.2%, respectively. No significant differences in OS were found among curability categories. The Cox proportional hazards model revealed the geriatric nutritional risk index (GNRI) and the Charlson comorbidity index (CCI) to be predictors of 3-year survival. We established a final model (EGC-2 model) expressed by GNRI - (2.2×CCI) with a cutoff value of 96. The overall survival rate was significantly lower in the model value < 96 group than in the model value ≥ 96 group (P < 0.001). CONCLUSIONS: The prediction model using GNRI and CCI will be useful to support decision-making for the treatment of EGC in elderly patients aged ≥ 85 years.
PURPOSE: Little is known about the prognostic factors for survival after endoscopic submucosal dissection (ESD) in elderly patients with early gastric cancer (EGC). The aim of this study is to determine prognostic factors and a prediction model of 3-year survival after ESD for EGC in patients aged ≥ 85 years. METHODS: We retrospectively evaluated the clinical outcomes of 740 patients with EGC aged ≥ 85 years, who were treated by ESD at 30 institutions in Japan. Overall survival (OS) and disease-specific survival (DSS) were calculated with the Kaplan-Meier method. Prediction models for 3-year OS after ESD were estimated using the Cox proportional hazards model based on Uno's C-statistics. RESULTS: During the follow-up period, 309 patients died of any cause and 10 patients died of gastric cancer. OS and DSS after 3 years were 82.7% and 99.2%, respectively. No significant differences in OS were found among curability categories. The Cox proportional hazards model revealed the geriatric nutritional risk index (GNRI) and the Charlson comorbidity index (CCI) to be predictors of 3-year survival. We established a final model (EGC-2 model) expressed by GNRI - (2.2×CCI) with a cutoff value of 96. The overall survival rate was significantly lower in the model value < 96 group than in the model value ≥ 96 group (P < 0.001). CONCLUSIONS: The prediction model using GNRI and CCI will be useful to support decision-making for the treatment of EGC in elderly patients aged ≥ 85 years.
Authors: H Isomoto; S Shikuwa; N Yamaguchi; E Fukuda; K Ikeda; H Nishiyama; K Ohnita; Y Mizuta; J Shiozawa; S Kohno Journal: Gut Date: 2008-11-10 Impact factor: 23.059