Survival analysis of elderly patients over 65 years old with stage II/III gastric cancer treated with adjuvant chemotherapy after laparoscopic D2 gastrectomy: a retrospective cohort study

Abstract Background The benefits of adjuvant chemotherapy for elderly patients with gastric cancer (GC) remain unknown because elderly patients are underrepresented in most clinical trials. This study aimed to evaluate the effectiveness and complications of adjuvant chemotherapy in patients > 65 years of age after laparoscopic D2 gastrectomy. Methods This was a single-center retrospective cohort study of elderly patients (> 65 years) with stage II/III GC who underwent curative laparoscopic D2 gastrectomy with R0 resection between 2004 and 2018. The adjuvant chemotherapy regimens included monotherapy (oral capecitabine) and doublet chemotherapy (oral capecitabine plus intravenous oxaliplatin [XELOX] or intravenous oxaliplatin, leucovorin, and 5-fluorouracil [FOLFOX]). The data were retrieved from a prospectively registered database maintained at the Department of General Surgery in Nanfang Hospital, China. The patients were divided as surgery alone and surgery plus adjuvant chemotherapy (chemo group). The overall survival (OS), disease-free survival (DFS), chemotherapy duration, and toxicity were examined. Results There were 270 patients included: 169 and 101 in the surgery and chemo groups, respectively. There were 10 (10/101) and six (6/101) patients with grade 3+ non-hematological and hematological adverse events. The 1−/3−/5-year OS rates of the surgery group were 72.9%/51.8%/48.3%, compared with 90.1%/66.4%/48.6% for the chemo group (log-rank test: P = 0.018). For stage III patients, the 1−/3−/5-year OS rates of the surgery group were 83.7%/40.7%/28.7%, compared with 89.9%/61.2%/43.6% for the chemo group (log-rank test: P = 0.015). Adjuvant chemotherapy was significantly associated with higher OS (HR = 0.568, 95%CI: 0.357–0.903, P = 0.017) and DFS (HR = 0.511, 95%CI: 0.322–0.811, P = 0.004) in stage III patients. Conclusions This study suggested that adjuvant chemotherapy significantly improves OS and DFS compared with surgery alone in elderly patients with stage III GC after D2 laparoscopic gastrectomy, with a tolerable adverse event profile.

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Survival Analysis of Elderly Patients Over 65 Years Old With Stage Ii/iii Gastric Cancer Treated With Adjuvant Chemotherapy After Laparoscopic D2 Gastrectomy: a Retrospective Cohort Study

10.21203/rs.3.rs-58754/v1 ◽

2020 ◽

Author(s):

Yanrui Liang ◽

Liying Zhao ◽

Hao Chen ◽

Tian Lin ◽

Tao Chen ◽

...

Keyword(s):

Gastric Cancer ◽

Cohort Study ◽

Adjuvant Chemotherapy ◽

Elderly Patients ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Stage Iii ◽

Rank Test ◽

D2 Gastrectomy ◽

Log Rank Test

Abstract Background: The benefits of adjuvant chemotherapy for elderly patients (age >65) with gastric cancer (GC) remain unknown because elderly patients are underrepresented in most clinical trials. To evaluate the effectiveness and complications of adjuvant chemotherapy in elderly patients (>65 years of age) after laparoscopic D2 gastrectomy.Methods: This was a retrospective cohort study of elderly patients (>65 years) with stage II/III GC who underwent curative laparoscopic D2 gastrectomy between 2004 and 2018. The patients were divided as surgery alone and surgery plus adjuvant chemotherapy (chemo group). The overall survival (OS), disease-free survival (DFS), circulating tumor cells (CTCs), chemotherapy duration, and toxicity were examined. Results: There were 270 patients included: 169 and 101 in the surgery and chemo groups, respectively. There were ten (10/101) and six (6/101) patients with grade 3+ non-hematological and hematological adverse events. The 1-/3-/5-year OS rates of the surgery group were 72.9%/51.8%/48.3%, compared with 90.1%/66.4%/48.6% for the chemo group (log-rank test: P=0.018). For stage III patients, the 1-/3-/5-year OS rates of the surgery group were 83.7%/40.7%/28.7%, compared with 89.9%/61.2%/43.6% for the chemo group (log-rank test: P=0.015). Adjuvant chemotherapy was significantly associated with higher OS (HR=0.568, 95%CI: 0.357-0.903, P=0.017) and DFS (HR=0.511, 95%CI: 0.322-0.811, P=0.004) in stage III patients. CTC >0 had no significant impact on the benefits of adjuvant chemotherapy on OS and DFS.Conclusions: This study suggested that adjuvant chemotherapy significantly improves OS and DFS for elderly patients with stage III GC after D2 laparoscopic gastrectomy, with a tolerable adverse event profile.

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Correction to: Survival analysis of elderly patients over 65 years old with stage II/III gastric cancer treated with adjuvant chemotherapy after laparoscopic D2 gastrectomy: a retrospective cohort study

BMC Cancer ◽

10.1186/s12885-021-08037-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yanrui Liang ◽

Liying Zhao ◽

Hao Chen ◽

Tian Lin ◽

Tao Chen ◽

...

Keyword(s):

Gastric Cancer ◽

Cohort Study ◽

Survival Analysis ◽

Adjuvant Chemotherapy ◽

Elderly Patients ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Stage Ii ◽

D2 Gastrectomy

An amendment to this paper has been published and can be accessed via the original article.

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Effectiveness of the Bactiseal Universal Shunt for reducing shunt infection in a sub-Saharan African context: a retrospective cohort study in 160 Ugandan children

Journal of Neurosurgery Pediatrics ◽

10.3171/2013.11.peds13394 ◽

2014 ◽

Vol 13 (2) ◽

pp. 140-144 ◽

Cited By ~ 19

Author(s):

Jordan D. Lane ◽

John Mugamba ◽

Peter Ssenyonga ◽

Benjamin C. Warf

Keyword(s):

Cohort Study ◽

Low Income ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Shunt Infection ◽

Low Income Countries ◽

Rank Test ◽

Log Rank Test ◽

Significant Difference ◽

Chi Square Analysis

Object Antibiotic-impregnated shunts have yet to find widespread use in the developing world, largely due to cost. Given potential differences in the microbial spectrum, their effectiveness in preventing shunt infection for populations in low-income countries may differ and has not been demonstrated. This study is the first to compare the efficacy of a Bactiseal shunt system with a non–antibiotic-impregnated system in a developing country. Methods The Bactiseal Universal Shunt (BUS) was placed in 80 consecutive Ugandan children who required a shunt. In this retrospective cohort study, the outcome for that group was compared with the outcome for the immediately preceding 80 consecutive children in whom a Chhabra shunt had been placed. The primary end points were shunt failure, shunt infection, and death. Shunt survival was analyzed using the Kaplan-Meier method. Significance of differences between groups was tested using the log-rank test, chi-square analysis, Fisher's exact test, and t-test. Results There was no difference between groups in regard to age, sex, or etiology of hydrocephalus. Mean follow-up for cases of nonfailure was 7.6 months (median 7.8 months, interquartile range 6.5–9.5 months). There was no significant difference between groups for any end point. The BUS group had fewer infections (4 vs 11), but the difference was not significant (p = 0.086, log-rank test). Gram-positive cocci were the most common culturable pathogens in the Chhabra group, while the only positive culture in the BUS group was a gram-negative rod. Conclusions These results provide equipoise for a randomized controlled trial in the same population and this has been initiated. It is possible that the observed trends may become significant in a larger study. The more complex task will involve determining not only the efficacy, but also the cost-effectiveness of using antibiotic-impregnated shunt components in limited-resource settings.

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Evaluation of Intensive Adjuvant Chemotherapy in Gastric Cancer Using Life Expectancy Compared with Log-Rank Test as a Measure of Survival Benefit

Annals of Surgical Oncology ◽

10.1245/s10434-006-9134-5 ◽

2006 ◽

Vol 14 (2) ◽

pp. 348-354 ◽

Cited By ~ 4

Author(s):

Toshikuni Nishikawa ◽

Shunzo Maetani

Keyword(s):

Gastric Cancer ◽

Adjuvant Chemotherapy ◽

Life Expectancy ◽

Survival Benefit ◽

Rank Test ◽

Log Rank Test

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Comparison of capecitabine and oxaliplatin with S-1 as adjuvant chemotherapy in stage III gastric cancer after D2 gastrectomy

PLoS ONE ◽

10.1371/journal.pone.0186362 ◽

2017 ◽

Vol 12 (10) ◽

pp. e0186362 ◽

Cited By ~ 6

Author(s):

Jang Ho Cho ◽

Jae Yun Lim ◽

Jae Yong Cho

Keyword(s):

Gastric Cancer ◽

Adjuvant Chemotherapy ◽

Stage Iii ◽

D2 Gastrectomy

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Adjuvant Chemotherapy for Elderly Patients with Gastric Cancer after D2 Gastrectomy

PLoS ONE ◽

10.1371/journal.pone.0053149 ◽

2013 ◽

Vol 8 (1) ◽

pp. e53149 ◽

Cited By ~ 13

Author(s):

Ying Jin ◽

Miao-zhen Qiu ◽

De-shen Wang ◽

Dong-sheng Zhang ◽

Chao Ren ◽

...

Keyword(s):

Gastric Cancer ◽

Adjuvant Chemotherapy ◽

Elderly Patients ◽

D2 Gastrectomy

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Appraisal of Long-time Outcomes After Curative Surgery in Elderly Patients with Gastric Cancer: A Propensity Score Matching Analysis

10.21203/rs.3.rs-75500/v1 ◽

2020 ◽

Author(s):

Tomoyuki Matunaga ◽

Ryo Ishiguro ◽

Wataru Miyauchi ◽

Yuji Shishido ◽

Kozo Miyatani ◽

...

Keyword(s):

Gastric Cancer ◽

Adjuvant Chemotherapy ◽

Propensity Score ◽

Elderly Patients ◽

Propensity Score Matching ◽

Cancer Patients ◽

Stage Iii ◽

Disease Specific Survival ◽

Gastric Cancer Patients ◽

Disease Specific

Abstract Background: This study was conducted to assess the long-term outcomes of elderly patients among propensity-score-matched gastric cancer patients after curative gastrectomy and to propose the proper management of elderly gastric cancer patients.Methods: We enrolled 626 patients with gastric cancer who underwent curative gastrectomy at our institution between January 2004 and December 2015. To minimize selection bias among 2 groups, propensity score matching was performed.Results: Patients were divided into an elderly group over 75 years old (EP group; n=186) and a non-elderly group (NEP group; n=440). After propensity score matching, patients were divided into EP group (n=186) and NEP group (n=186). Five-year overall survival was significantly lower in the EP group than in the NEP group, consistent with a subgroup analysis of each stage. However, the 5-year disease-specific survival among all enrolled patients and those with stage I and II disease did not differ significantly. Moreover, in the subgroup of stage III patients, 5-year disease-specific survival was significantly lower in the EP group (23.0%) than in the NEP group (59.4%; P=0.004). Because elderly patients with stage III disease had an extremely poor prognosis, we decided to compare the two groups with stage III. The EP group contained significantly fewer patients with D2 lymphadectomy (P=0.002) and adjuvant chemotherapy (P<0.001) than the NEP group. Multivariate analysis revealed that older age and lymphatic invasion were independent prognostic factors. C-reactive protein to albumin ratio was significantly higher in patients in the EP group than in the NEP group (P=0.046), and the prognostic nutritional index was significantly lower in EP group patients than NEP group patients (P=0.045). Conclusions: Elderly gastric cancer patients with stage III disease showed poorer disease-specific survival compared with non-elderly patients, which may be due to fewer D2 lymphadenectomies, a lack of adjuvant chemotherapy, and a poorer nutritional and inflammatory background. The safe induction of standard lymphadenectomy and adjuvant chemotherapy with perioperative aggressive nutritional support may improve the prognosis of elderly gastric cancer patients with stage III disease.

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