Population-based outcomes research on treatment patterns and impact of chemotherapy in older patients with metastatic gastric cancer

  • Keun-Wook Lee
  • Ju Hyun Lee
  • Jin Won Kim
  • Ji-Won Kim
  • Soyeon Ahn
  • Jee Hyun KimEmail author
Original Article – Clinical Oncology



Older patients with cancer are underrepresented in clinical trials, and thus, limited data are available on older patients with metastatic gastric cancer (MGC). This study was conducted to assess patterns of care, and outcomes of chemotherapy and its predictors, in older patients with MGC.


Using the Korean Health Insurance Review and Assessment Service (HIRA) database, a nationwide population-based outcomes study was conducted. From the HIRA database, patients newly diagnosed with MGC in 2010 were identified (N = 1871).


Patients aged ≥70 years were defined as older patients (N = 792) and those aged <70 years as younger patients (N = 1079). Compared with younger patients, fewer older patients were diagnosed with MGC and received cancer treatment at high-volume medical institutions. Palliative chemotherapy was less frequently administered in older patients than in younger patients. In multivariate analyses, although combination chemotherapy as the first-line treatment (vs. monotherapy) and salvage chemotherapy after first-line chemotherapy (vs. no salvage chemotherapy) conferred more prolonged survival in the entire patient population, first-line combination chemotherapy did not provide an additional survival benefit in older patients compared to monotherapy.


We found several barriers for older patients in approaching high-quality medical resources or receiving appropriate treatments. Although age was not an independent prognostic factor for survival in MGC, palliative chemotherapy was less frequently used in older patients. In our analysis, combination chemotherapy as the first-line treatment did not provide an additional benefit to older patients compared to monotherapy.


Gastric cancer Older patients Chemotherapy Outcomes research 



This study was funded by Grant number 1320370 from the National R&D Program for Cancer Control, Ministry for Health and Welfare, Republic of Korea.

Compliance with ethical standards

Conflict of interest

We declare that we have no conflict of interest.

Ethical approval

Because the HIRA database does not include patient identifiers, for this type of study formal consent is not required. Exemption of IRB approval was approved by local IRB of Seoul National University Bundang Hospital (Z-2015-29).

Supplementary material

432_2015_2075_MOESM1_ESM.xls (34 kb)
Supplementary material 1 (XLS 33 kb)


  1. Cheon SH, Rha SY, Jeung HC et al (2008) Survival benefit of combined curative resection of the stomach (D2 resection) and liver in gastric cancer patients with liver metastases. Ann Oncol 19:1146–1153CrossRefPubMedGoogle Scholar
  2. Ferlay J, Soerjomataram I, Dikshit R et al (2014) Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136:E359–386CrossRefPubMedGoogle Scholar
  3. Jang MJ, Bang SM, Oh D (2011) Incidence of venous thromboembolism in Korea: from the Health Insurance Review and Assessment Service database. J Thromb Haemost 9:85–91CrossRefPubMedGoogle Scholar
  4. Jung KW, Won YJ, Kong HJ et al (2013) Survival of Korean adult cancer patients by stage at diagnosis, 2006–2010: national cancer registry study. Cancer Res Treat 45:162–171PubMedCentralCrossRefPubMedGoogle Scholar
  5. Jung KW, Won YJ, Kong HJ et al (2015) Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2012. Cancer Res Treat 47:127–141PubMedCentralCrossRefPubMedGoogle Scholar
  6. Kelley JR, Duggan JM (2003) Gastric cancer epidemiology and risk factors. J Clin Epidemiol 56:1–9CrossRefPubMedGoogle Scholar
  7. Kim DS (2010) Introduction: health of the health care system in Korea. Soc Work Public Health 25:127–141CrossRefPubMedGoogle Scholar
  8. Kim KH, Lee KW, Baek SK et al (2011) Survival benefit of gastrectomy ± metastasectomy in patients with metastatic gastric cancer receiving chemotherapy. Gastric Cancer 14:130–138CrossRefPubMedGoogle Scholar
  9. Kim ST, Park KH, Oh SC et al (2012) Is chemotherapy in elderly patients with metastatic or recurrent gastric cancer as tolerable and effective as in younger patients? Asia Pac J Clin Oncol 8:194–200CrossRefPubMedGoogle Scholar
  10. Kim HS, Kim HJ, Kim SY et al (2013) Second-line chemotherapy versus supportive cancer treatment in advanced gastric cancer: a meta-analysis. Ann Oncol 24:2850–2854CrossRefPubMedGoogle Scholar
  11. Kitamura K, Yamaguchi T, Taniguchi H et al (1996) Clinicopathological characteristics of gastric cancer in the elderly. Br J Cancer 73:798–802PubMedCentralCrossRefPubMedGoogle Scholar
  12. Koo DH, Ryoo BY, Kim HJ et al (2011) A prognostic model in patients who receive chemotherapy for metastatic or recurrent gastric cancer: validation and comparison with previous models. Cancer Chemother Pharmacol 68:913–921CrossRefPubMedGoogle Scholar
  13. Koo DH, Ryu MH, Ryoo BY et al (2015) Improving trends in survival of patients who receive chemotherapy for metastatic or recurrent gastric cancer: 12 years of experience at a single institution. Gastric Cancer 18:346–353CrossRefPubMedGoogle Scholar
  14. Lewis JH, Kilgore ML, Goldman DP et al (2003) Participation of patients 65 years of age or older in cancer clinical trials. J Clin Oncol 21:1383–1389CrossRefPubMedGoogle Scholar
  15. Murthy VH, Krumholz HM, Gross CP (2004) Participation in cancer clinical trials: race-, sex-, and age-based disparities. JAMA 291:2720–2726CrossRefPubMedGoogle Scholar
  16. Park C, Ha YC, Jang S et al (2011) The incidence and residual lifetime risk of osteoporosis-related fractures in Korea. J Bone Miner Metab 29:744–751CrossRefPubMedGoogle Scholar
  17. Sun DS, Jeon EK, Won HS et al (2015) Outcomes in elderly patients treated with a single-agent or combination regimen as first-line chemotherapy for recurrent or metastatic gastric cancer. Gastric Cancer 18:644–652CrossRefPubMedGoogle Scholar
  18. Waddell T, Verheij M, Allum W et al (2013) Gastric cancer: ESMO–ESSO–ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 24(Suppl 6):vi57–63CrossRefPubMedGoogle Scholar
  19. Wagner AD, Grothe W, Haerting J et al (2006) Chemotherapy in advanced gastric cancer: a systematic review and meta-analysis based on aggregate data. J Clin Oncol 24:2903–2909CrossRefPubMedGoogle Scholar
  20. Wohrer SS, Raderer M, Hejna M (2004) Palliative chemotherapy for advanced gastric cancer. Ann Oncol 15:1585–1595CrossRefPubMedGoogle Scholar
  21. Yhim HY, Jang MJ, Bang SM et al (2014) Incidence of venous thromboembolism following major surgery in Korea: from the Health Insurance Review and Assessment Service database. J Thromb Haemost 12:1035–1043CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Keun-Wook Lee
    • 1
  • Ju Hyun Lee
    • 1
  • Jin Won Kim
    • 1
  • Ji-Won Kim
    • 1
  • Soyeon Ahn
    • 2
  • Jee Hyun Kim
    • 1
    Email author
  1. 1.Department of Internal Medicine, Seoul National University College of MedicineSeoul National University Bundang HospitalSeongnam-siRepublic of Korea
  2. 2.Division of Statistics, Medical Research Collaborating CenterSeoul National University Bundang HospitalSeongnam-siRepublic of Korea

Personalised recommendations