Comorbidities related to metachronous recurrence for early gastric cancer in elderly patients

Table 1 A comparison between baseline and clinicopathological characteristics of elderly patients in different groups, n (%)

Characteristics	Number (n = 653)	Non-MGC (n = 607)	MGC (n = 46)	P value
Age, years (IQR)	70 (67-74)	70 (67-74)	69 (67-73)	0.186
Sex				0.354
Male	465 (71.2)	429 (70.7)	36 (78.3)
Female	188 (28.8)	178 (29.3)	10 (21.7)
Tobacco abuse	225 (34.5)	205 (33.8)	20 (43.5)	0.240
Alcohol abuse	180 (27.6)	166 (27.3)	14 (30.4)	0.779
Family history of cancer	101 (15.5)	92 (15.2)	9 (19.6)	0.558
MASLD	63 (9.7)	53 (8.73)	10 (21.7)	0.008
Hypertension	202 (30.9)	185 (30.5)	17 (37.0)	0.453
Diabetes	68 (10.4)	62 (10.2)	6 (13.0)	0.614
Cardiovascular disease	55 (8.4)	52 (8.6)	3 (6.5)	0.837
Cerebrovascular disease	43 (6.6)	37 (6.1)	6 (13.0)	0.111
H. pylori infection				< 0.001
Negative	99 (15.2)	95 (15.7)	4 (8.70)
Eradicated	508 (77.8)	481 (79.2)	27 (58.7)
Persistent	46 (7.0)	31 (5.1)	15 (32.6)
Baseline atrophy				0.031
Mild/moderate (C0-C3)	479 (73.4)	452 (74.5)	27 (58.7)
Severe (O1-O3)	174 (26.6)	155 (25.5)	19 (41.3)
Location				0.593
Cardia	323 (49.5)	298 (49.1)	25 (54.3)
Non-cardia	330 (50.5)	309 (50.9)	21 (45.7)
Macroscopic shape				0.034
Elavated (I, IIa)	220 (33.7)	206 (33.9)	14 (30.4)
Flated (IIb)	180 (27.6)	160 (26.4)	20 (43.5)
Depressed (IIc, III)	253 (38.7)	241 (39.7)	12 (26.1)
Tumor size, cm				0.614
< 2	371 (56.8)	347 (57.2)	24 (52.2)
≥ 2	282 (43.2)	260 (42.8)	22 (47.8)
Depth of invasion				1
Mucosa	488 (74.7)	454 (74.8)	34 (73.9)
Submucosa	165 (25.3)	153 (25.2)	12 (26.1)
Differentiation				0.047
WD/MD	581 (89.0)	536 (88.3)	45 (97.8)
PD	72 (11.0)	71 (11.7)	1 (2.2)
Ulceration	46 (7.0)	41 (6.8)	5 (10.9)	0.452
Initial multifocality	121 (18.5)	107 (17.6)	14 (30.4)	0.050
Median follow-up time, months	38 (25-55)	38 (26-56)	29 (19-45)	0.001

C: Closed; MASLD: Metabolic dysfunction-associated steatotic liver disease; MD: Moderately differentiated; O: Open; PD: Poorly differentiated; WD: Well-differentiated; H. pylori: Helicobacter pylori; MGC: Metachronous gastric cancer.

Table 2 Univariate and multivariate Cox analyses of risk factors for metachronous gastric carcinoma development

Characteristics	Univariate analysis		Multivariate analysis		Risk
	HR (95%CI)	P value	HR (95%CI)	P value	Points1
Age, years	0.95 (0.89-1.02)	0.142
Sex		0.342
Male	Reference
Female	0.71 (0.35-1.44)
Tobacco abuse	1.47 (0.82-2.64)	0.191
Alcohol abuse	1.17 (0.62-2.19)	0.628
Family history of cancer	1.47 (0.71-3.04)	0.298
MASLD	3.35 (1.65-6.79)	< 0.001	2.44 (1.15-5.17)	0.020	1
Hypertension	1.47 (0.81-2.68)	0.206
Diabetes	1.44 (0.61-3.41)	0.404
Cardiovascular disease	0.74 (0.23-2.38)	0.609
Cerebrovascular disease	2.46 (1.04-5.82)	0.034	1.79 (0.72-4.42)	0.207
H. pylori infection		< 0.001
Negative	Reference		Reference
Eradicated	1.46 (0.51-4.17)		1.17 (0.41-3.38)	0.769
Persistent	11.8 (3.89-35.8)		10.38 (3.36-32.07)	< 0.001	3
Baseline atrophy		0.002
Mild/moderate (C0-C3)	Reference		Reference
Severe (O1-O3)	2.47 (1.37-4.46)		2.71 (1.45-5.08)	0.002	1
Location		0.977
Cardia	Reference
Non-cardia	0.99 (0.55-1.78)
Macroscopic shape		0.015
Elavated (I, IIa)	Reference
Flated (IIb)	2.17 (1.09-4.32)		2.22 (1.07-4.59)	0.031
Depressed (IIc, III)	0.87 (0.40-1.89)		0.77 (0.34-1.75)	0.537
Tumor size, cm		0.727
< 2	Reference
≥ 2	1.11 (0.62-1.98)
Depth of invasion		0.789
Mucosa	Reference
Submucosa	0.91 (0.47-1.77)
Differentiation		0.039		0.027
WD/MD	6.21 (0.86-45.0)		10.18 (1.30-79.65)		3
PD	Reference		Reference
Ulceration	1.32 (0.52-3.34)	0.562
Initial multifocality	2.17 (1.15-4.07)	0.014	1.79 (0.90-3.56)	0.096

¹The coefficient of each variable was divided by 0.387 (the lowest log hazard ratio value), corresponding to metabolic dysfunction-associated steatotic liver disease, and rounded to the nearest integer.

C: Closed; MASLD: Metabolic dysfunction-associated steatotic liver disease; MD: Moderately differentiated; O: Open; PD: Poorly differentiated; WD: Well-differentiated; H. pylori: Helicobacter pylori; HR: Hazard ratio; CI: Confidence interval.

Table 3 Risk stratification based on the independent risk factors for metachronous gastric carcinoma in elderly patients

Risk stratification	Total points	Total patients (n = 653)	MGC (n = 46)	Rate of MGC (%)	Cumulative hazard	95%CI
Low	0-1	526	27	5.1	12.3	6.4-18.2
Intermediate	2-3	88	11	12.5	21.6	8.9-34.3
High	4-8	39	8	20.5	45	16.1-73.8

MGC: Metachronous gastric carcinoma; CI: Confidence interval.