Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
권호 표지
DOI QR코드

DOI QR Code

Could Adjuvant Chemotherapy after Surgery Benefit Elderly Patients with Advanced Gastric Cancer?

  • Jeong, Jin Woon (Department of Surgery, Keimyung University School of Medicine) ;
  • Kwon, In Gyu (Department of Surgery, Keimyung University School of Medicine) ;
  • Son, Young-Gil (Department of Surgery, Keimyung University School of Medicine) ;
  • Ryu, Seung Wan (Department of Surgery, Keimyung University School of Medicine)
  • Received : 2016.10.21
  • Accepted : 2016.10.27
  • Published : 2016.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The aim of this study was to evaluate tolerance to adjuvant chemotherapy, and to compare survival between treatments using only surgery and using surgery with adjuvant chemotherapy, in elderly patients with advanced gastric cancer who were ${\geq}75years$ of age. Materials and Methods: Patients ${\geq}75years$ of age who were diagnosed with pathological stage II or III gastric cancer were identified retrospectively and categorized into the surgery only and surgery with adjuvant chemotherapy groups. Clinicopathological and survival data were compared between these two groups. Results: Among the 130 patients studied, 67 patients underwent curative surgery only, and 63 patients received adjuvant chemotherapy after curative surgery. In the latter group, adverse events were reported in 24 patients (38.1%). The treatments were discontinued in 19 patients (30.2%) owing to any reason. The overall 5-year survival rates of the surgery only and the surgery with adjuvant chemotherapy groups did not differ significantly (44.1% vs. 30.7%, respectively; P=0.804). Among 90 death events, deaths from recurrences of gastric cancer occurred in 42 patients. Multivariate analyses revealed that the American Society of Anesthesiologists score and the depths of tumor invasions were related to survival, and the addition of adjuvant chemotherapy after surgery did not influence survival. Conclusions: The decision for the addition of adjuvant chemotherapy for elderly patients should be taken after considering the condition of individual patients and their life expectancies.

Keywords

References

  1. Edwards BK, Howe HL, Ries LA, Thun MJ, Rosenberg HM, Yancik R, et al. Annual report to the nation on the status of cancer, 1973-1999, featuring implications of age and aging on U.S. cancer burden. Cancer 2002;94:2766-2792. https://doi.org/10.1002/cncr.10593
  2. Shin A, Kim J, Park S. Gastric cancer epidemiology in Korea. J Gastric Cancer 2011;11:135-140. https://doi.org/10.5230/jgc.2011.11.3.135
  3. Korean Statistical Information Service. Statistical Database; Population/Household [Internet]. Daejeon: Korean Statistical Information Service; 2016 [cited 2016 Oct 21]. Available from: http://kosis.kr/statisticsList/statisticsList_01List.jsp?vwcd=MT_ZTITLE&parentId=A#SubCont.
  4. Korenaga D, Moriguchi S, Baba H, Kakeji Y, Orita H, Haraguchi M, et al. Surgery for gastric carcinoma is feasible for patients over 80 years of age. World J Surg 1991;15:642-647; discussion 647-648. https://doi.org/10.1007/BF01789215
  5. Hanazaki K, Wakabayashi M, Sodeyama H, Miyazawa M, Yokoyama S, Sode Y, et al. Surgery for gastric cancer in patients older than 80 years of age. Hepatogastroenterology 1998;45:268-275.
  6. Jung HS, Park YK, Ryu SY, Jeong O. Laparoscopic total gastrectomy in elderly patients ($\geq$70 years) with gastric carcinoma: a retrospective study. J Gastric Cancer 2015;15:176-182. https://doi.org/10.5230/jgc.2015.15.3.176
  7. Kwon IG, Cho I, Guner A, Kim HI, Noh SH, Hyung WJ. Minimally invasive surgery as a treatment option for gastric cancer in the elderly: comparison with open surgery for patients 80 years and older. Surg Endosc 2015;29:2321-2330. https://doi.org/10.1007/s00464-014-3955-2
  8. Yamada T, Hayashi T, Aoyama T, Shirai J, Fujikawa H, Cho H, et al. Feasibility of enhanced recovery after surgery in gastric surgery: a retrospective study. BMC Surg 2014;14:41. https://doi.org/10.1186/1471-2482-14-41
  9. Yamada Y, Higuchi K, Nishikawa K, Gotoh M, Fuse N, Sugimoto N, et al. Phase III study comparing oxaliplatin plus S-1 with cisplatin plus S-1 in chemotherapy-naive patients with advanced gastric cancer. Ann Oncol 2015;26:141-148. https://doi.org/10.1093/annonc/mdu472
  10. Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med 2007;357:1810-1820. https://doi.org/10.1056/NEJMoa072252
  11. Sasako M, Sakuramoto S, Katai H, Kinoshita T, Furukawa H, Yamaguchi T, et al. Five-year outcomes of a randomized phase III trial comparing adjuvant chemotherapy with S-1 versus surgery alone in stage II or III gastric cancer. J Clin Oncol 2011;29:4387-4393. https://doi.org/10.1200/JCO.2011.36.5908
  12. Bang YJ, Kim YW, Yang HK, Chung HC, Park YK, Lee KH, et al. Adjuvant capecitabine and oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): a phase 3 open-label, randomised controlled trial. Lancet 2012;379:315-321. https://doi.org/10.1016/S0140-6736(11)61873-4
  13. GASTRIC (Global Advanced/Adjuvant Stomach Tumor Research International Collaboration) Group, Paoletti X, Oba K, Burzykowski T, Michiels S, Ohashi Y, et al. Benefit of adjuvant chemotherapy for resectable gastric cancer: a meta-analysis. JAMA 2010;303:1729-1737. https://doi.org/10.1001/jama.2010.534
  14. Wedding U, Honecker F, Bokemeyer C, Pientka L, Hoffken K. Tolerance to chemotherapy in elderly patients with cancer. Cancer Control 2007;14:44-56.
  15. Murad AM, Santiago FF, Petroianu A, Rocha PR, Rodrigues MA, Rausch M. Modified therapy with 5-fluorouracil, doxorubicin, and methotrexate in advanced gastric cancer. Cancer 1993;72:37-41. https://doi.org/10.1002/1097-0142(19930701)72:1<37::AID-CNCR2820720109>3.0.CO;2-P
  16. Glimelius B, Hoffman K, Haglund U, Nyren O, Sjoden PO. Initial or delayed chemotherapy with best supportive care in advanced gastric cancer. Ann Oncol 1994;5:189-190. https://doi.org/10.1093/oxfordjournals.annonc.a058778
  17. Wagner AD, Unverzagt S, Grothe W, Kleber G, Grothey A, Haerting J, et al. Chemotherapy for advanced gastric cancer. Cochrane Database Syst Rev 2010;(3):CD004064.
  18. Monfardini S, Sorio R, Boes GH, Kaye S, Serraino D. Entry and evaluation of elderly patients in European Organization for Research and Treatment of Cancer (EORTC) new-drugdevelopment studies. Cancer 1995;76:333-338. https://doi.org/10.1002/1097-0142(19950715)76:2<333::AID-CNCR2820760226>3.0.CO;2-I
  19. Kim MC, Kim W, Kim HH, Ryu SW, Ryu SY, Song KY, et al. Risk factors associated with complication following laparoscopy-assisted gastrectomy for gastric cancer: a large-scale korean multicenter study. Ann Surg Oncol 2008;15:2692-2700. https://doi.org/10.1245/s10434-008-0075-z
  20. Noh SH, Park SR, Yang HK, Chung HC, Chung IJ, Kim SW, et al. Adjuvant capecitabine plus oxaliplatin for gastric cancer after D2 gastrectomy (CLASSIC): 5-year follow-up of an openlabel, randomised phase 3 trial. Lancet Oncol 2014;15:1389-1396. https://doi.org/10.1016/S1470-2045(14)70473-5

Cited by

  1. Proposal of a Scoring Scale to Estimate Risk of the Discontinuation of S-1 Adjuvant Monotherapy in Patients with Stage II to III Gastric Cancer: A Multi-Institutional Dataset Analysis vol.43, pp.8, 2016, https://doi.org/10.1007/s00268-019-04942-y
  2. Optimal treatment for elderly patients with resectable proximal gastric carcinoma: a real world study based on National Cancer Database vol.19, pp.1, 2016, https://doi.org/10.1186/s12885-019-6166-3
  3. An examination of surgical and survival outcomes in the elderly (65-79 years of age) and the very elderly (≥80 years of age) who received surgery for gastric cancer vol.36, pp.2, 2020, https://doi.org/10.1080/03007995.2018.1520083
  4. Is surgery the best treatment for elderly gastric cancer patients? vol.13, pp.11, 2016, https://doi.org/10.4240/wjgs.v13.i11.1351