Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jun 15, 2017; 9(6): 257-262
Published online Jun 15, 2017. doi: 10.4251/wjgo.v9.i6.257
Effects of age on survival and morbidity in gastric cancer patients undergoing gastrectomy
Yoshinori Fujiwara, Shuichi Fukuda, Masanori Tsujie, Hajime Ishikawa, Kotaro Kitani, Keisuke Inoue, Masao Yukawa, Masatoshi Inoue
Yoshinori Fujiwara, Shuichi Fukuda, Masanori Tsujie, Hajime Ishikawa, Kotaro Kitani, Keisuke Inoue, Masao Yukawa, Masatoshi Inoue, Department of Digestive Surgery, Nara Hospital, Kindai University School of Medicine, Ikoma, Nara 630-0293, Japan
Yoshinori Fujiwara, Department of Digestive Surgery, Kawasaki Medical School, Kurashiki, Okayama 701-0192, Japan
Author contributions: Fujiwara Y, Fukuda S and Tsujie M planned this study, and performed the data collection and statistical analysis; Ishikawa H, Kitani K, Inoue K, Yukawa M and Inoue M supported this study; all authors have read and approved the final version.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Nara Hospital, Kindai University.
Informed consent statement: Comprehensive agreement of clinical study was obtained in all patients at admission of our hospital. The analysis used anonymous and the detail of this study are published on the homepage of Nara Hospital, Kindai University.
Conflict-of-interest statement: We have no financial relationship to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Yoshinori Fujiwara, MD, Department of Digestive Surgery, Kindai University School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan. yyfujiwara@nifty.com
Telephone: +81-86-4621111 Fax: +81-86-4621199
Received: December 25, 2016
Peer-review started: December 31, 2016
First decision: February 4, 2017
Revised: February 24, 2017
Accepted: May 18, 2017
Article in press: May 19, 2017
Published online: June 15, 2017
Processing time: 170 Days and 19.2 Hours
Abstract
AIM

To evaluate clinicopathological features and surgical outcomes of gastric cancer in elderly and non-elderly patients after inverse probability of treatment weighting (IPTW) method using propensity score.

METHODS

We enrolled a total of 448 patients with histologically confirmed primary gastric carcinoma who received gastrectomies. Of these, 115 patients were aged > 80 years old (Group A), and 333 patients were aged < 79 years old (Group B). We compared the surgical outcomes and survival of the two groups after IPTW.

RESULTS

Postoperative complications, especially respiratory complications and hospital deaths, were significantly more common in Group A than in Group B (P < 0.05). Overall survival (OS) was significantly lower in Group A patients than in Group B patients. Among the subset of patients who had pathological Stage I disease, OS was significantly lower in Group A (P < 0.05) than Group B, whereas cause-specific survival was almost equal in the two groups. In multivariate analysis, pathological stage, histology, and extent of lymph node dissection were independent prognostic values for OS.

CONCLUSION

When the gastrectomy was performed in gastric cancer patients, we should recognized high mortality and comorbidities in that of elderly. More extensive lymph node dissection might improve prognoses of elderly gastric cancer patients.

Keywords: Gastric cancer; Mortality; Morbidity; Elderly; Lymphadenectomy; Propensity score matching; Prognosis; Survival

Core tip: Inverse probability of treatment weighting (IPTW) attempts to reduce the bias due to confounding variables in estimates of treatment effects. In the present study, we compared the surgical outcomes and survival of elderly gastric cancer patients with that of general population after IPTW. The overall survival of pStage I gastric cancer patients in elderly was lower survival due to death of other diseases. We found that extent of lymph nodes dissection were independent prognostic factors. When the gastrectomy was performed in gastric cancer patients, we should recognized high mortality and comorbidities in that of elderly. This study was reviewed and approved by Nara Hospital, Kindai University review board on human research.