TY - JOUR
T1 - Prognosis after curative resection for stage IA gastric cancer in elderly patients
T2 - endoscopic submucosal dissection versus surgery
AU - Miyahara, Koji
AU - Ishida, Michihiro
AU - Kono, Yoshiyasu
AU - Hirata, Tetsu
AU - Obayashi, Yuka
AU - Gotoda, Tatsuhiro
AU - Ninomiya, Yuki
AU - Moritou, Yuki
AU - Kunihiro, Masaki
AU - Kubota, Tetsushi
AU - Choda, Yasuhiro
AU - Shirakawa, Yasuhiro
AU - Nakagawa, Masahiro
AU - Okada, Hiroyuki
N1 - Publisher Copyright:
© 2022, The Author(s) under exclusive licence to Springer Nature Singapore Pte Ltd.
PY - 2022
Y1 - 2022
N2 - Purpose: To establish whether gastrectomy for early gastric cancer (EGC) in elderly patients is related to poor survival. Methods: The subjects of this retrospective study were patients aged ≥ 75 years with primary stage IA EGC, who underwent curative resection with endoscopic submucosal dissection (ESD) or surgery. Results: We analyzed data on 365 patients who underwent ESD and 170 patients who underwent surgery. Overall survival (OS) was not significantly different for the ESD group vs. the surgery group (5-year cumulative rates, 81.5% vs. 79.7%; log-rank test, P = 0.506). Multivariate analysis revealed that treatments; namely, ESD or surgery, were not associated with OS (hazard ratio 1.09, 95% confidence interval 0.77–1.51). Similar results were observed even in the subgroups with worse conditions, such as age > 80 years, Eastern Cooperative Oncology Group performance status 2–3, Charlson comorbidity index ≥ 2, and prognostic nutritional index ≤ 46.7. Using propensity score matching, we selected 88 pairs of patients who underwent ESD or surgery with baseline characteristics matched and found that OS was not different between the two groups (log-rank test, P = 0.829). Conclusion: OS was comparable for elderly patients who underwent ESD and those who underwent surgery for EGC. Surgical invasiveness did not worsen the prognosis, even for elderly patients.
AB - Purpose: To establish whether gastrectomy for early gastric cancer (EGC) in elderly patients is related to poor survival. Methods: The subjects of this retrospective study were patients aged ≥ 75 years with primary stage IA EGC, who underwent curative resection with endoscopic submucosal dissection (ESD) or surgery. Results: We analyzed data on 365 patients who underwent ESD and 170 patients who underwent surgery. Overall survival (OS) was not significantly different for the ESD group vs. the surgery group (5-year cumulative rates, 81.5% vs. 79.7%; log-rank test, P = 0.506). Multivariate analysis revealed that treatments; namely, ESD or surgery, were not associated with OS (hazard ratio 1.09, 95% confidence interval 0.77–1.51). Similar results were observed even in the subgroups with worse conditions, such as age > 80 years, Eastern Cooperative Oncology Group performance status 2–3, Charlson comorbidity index ≥ 2, and prognostic nutritional index ≤ 46.7. Using propensity score matching, we selected 88 pairs of patients who underwent ESD or surgery with baseline characteristics matched and found that OS was not different between the two groups (log-rank test, P = 0.829). Conclusion: OS was comparable for elderly patients who underwent ESD and those who underwent surgery for EGC. Surgical invasiveness did not worsen the prognosis, even for elderly patients.
KW - Early gastric cancer
KW - Elderly patients
KW - Endoscopic submucosal dissection
KW - Prognosis
KW - Surgery
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U2 - 10.1007/s00595-022-02456-0
DO - 10.1007/s00595-022-02456-0
M3 - Article
AN - SCOPUS:85123749350
JO - Japanese Journal of Surgery
JF - Japanese Journal of Surgery
SN - 0941-1291
ER -