| BACKGROUNDThe incidence of gastric cancer in elderly patients is gradually increasing in China.However,there are still no consensus about the clinicopathological features,surgical outcome,and long-term prognosis of elderly patients with gastric cancer.There are no specific guidelines for the elderly patients,because published data is very limited due to the strict selection and under-representation of elderly patients in clinical trials.Therefore,it is of importance to clarify whether gastric cancer in elderly patients has different clinicopathological characteristics,surgical outcome,and long-term prognosis from those in non-elderly patients,and to find some useful prognostic indicators to predict the risk for post-operative complications and survival in elderly gastric cancer patients.METHODSClinical data of patients with gastric cancer undergoing radical gastrectomy from January 2012 to December 2014 and from January 2017 to December 2017 at Ruijin Hospital Affiliated to Shanghai Jiaotong University were collected in this retrospective study.Patients were divided into two age groups(?70 and <70 years old),and were evaluated with respect to clinicopathological features,surgical outcome,long-term prognosis,and risk factors for postoperative complications and long-term prognosis.After balancing the intergroup variables by the propensity score matching(PSM)method,the relationship between age and postoperative complications in gastric cancer patients was validated.Models predicting short-term and long-term risks for postoperative patients with gastric cancer were established using nomograms.RESULTSCompared with non-elderly patients,elderly patients with gastric cancer had higher incidence of preoperative comorbidities,larger tumors,higher tumor differentiation,and poorer nutritional and immunological status.Surgeons tended to choose open surgery and to reduce the number of dissected lymph node when treating elderly patients with gastric cancer.Short-term prognostic factors such as the rate and severity of postoperative complications,length of hospitalization,and hospitalization costs were significantly worse in elderly gastric cancer patients.The increased incidence of postoperative complications in elderly gastric cancer patients was closely related to their clinicopathological features.Number of comorbidities and intraoperative fluid intake were independent risk factors for postoperative complications in elderly gastric cancer patients.Survival analysis showed that the survival rate of elderly gastric cancer patients was significantly lower than that of non-elderly patients.Signet-ring cell carcinoma,mucinous adenocarcinoma,and clinical stage were independent risk factors for survival rates in elderly gastric cancer patients.The survival rate of stage I?II patients with gastric cancer might be mainly determined by non-tumor factors,and the survival rate of stage III?IV patients with gastric cancer was jointly determined by both tumor and non-tumor factors.The nomogram predicting the risks for postoperative complications and survival rates of gastric cancer patients had certain predictive value.CONCLUSIONGastric cancer in the elderly represents a distinct entity with specific clinicopathological characteristics,surgical outcome,and long-term prognosis.The difference in postoperative complications is related to the unique clinicopathological features of elderly gastric cancer,and the difference in long-term survival may be related to non-tumor factors. |
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