Skip to main content

Advertisement

SpringerLink
Log in

Prognosis of elderly gastric cancer patients after surgery: a nomogram to predict survival

  • Original Paper
  • Published:
Medical Oncology Aims and scope Submit manuscript

Abstract

This study aimed to identify clinicopathological factors associated with the outcome of elderly patients with gastric cancer (GC), and to construct a nomogram for individual risk prediction. Tumor characteristics of 143 patients aged ≥ 80 years underwent surgery for GC were collected and analyzed by uni- and multivariate analyses. A prognostic nomogram was constructed using the factors which resulted to be significantly associated with overall survival. Discrimination of nomogram was tested by Kaplan–Meier (KM) curves and boxplots. With a median follow up of 18.37 months, overall 1-year survival rate was 51% and it was 60 and 40% for older and younger than 83 years, respectively (P = 0.003). Univariate analysis indicated that age (P = 0.008), pre-operatory performance status (P < 0.001), depth of invasion (P = 0.007), lymph nodes involvement (P < 0.001), and residual tumor (P < 0.001) were significant prognostic factors. Based on these variables, a nomogram to predict 3, 6, 12, and 24 months survival probability after GC surgery was developed. KM and boxplots according to the range of nomogram total points highlighted the appropriateness of distinguish the patients’ survival in all the subgroups. Moreover, this nomogram exhibited superior prognostic discrimination between intermediate stages (II–III) than AJCC-TNM classification. This study showed that after good surgical selection, the prognosis of elderly GC patients may be influenced by several clinicopathological factors. Therefore, a predictive nomogram to distinguish more accurately fit patients may allow physicians to individualize treatments and to detect those patients who may benefit from an intensive multidisciplinary approach.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Population structure and ageing - Statistics Explained, http://ec.europa.eu/eurostat/statistics-explained/index.php/Population_structure_and_ageing.

  2. Endo S, Dousei T, Yoshikawa Y, Hatanaka N, Kamiike W, Nishijima J. Prognosis of gastric carcinoma patients aged 85 years or older who underwent surgery or who received best supportive care only. Int J Clin Oncol. 2013;18(6):1014–9.

    Article  PubMed  Google Scholar 

  3. Endo S, Yoshikawa Y, Hatanaka N, Tominaga H, Shimizu Y, Hiraoka K, Nishitani A, Irei T, Nakashima S, Park M-H, Takahashi H, Wakahara M, Kamiike W. Treatment for gastric carcinoma in the oldest old patients. Gastric Cancer. 2011;14(2):139–43.

    Article  PubMed  Google Scholar 

  4. Fujimoto S, Takahashi M, Ohkubo H, Mutou T, Kure M, Masaoka H, Kobayashi K. Comparative clinicopathologic features of early gastric cancer in young and older patients. Surgery. 1994;115(4):516–20.

    PubMed  CAS  Google Scholar 

  5. Liang Y-X, Deng J-Y, Guo H-H, Ding X-W, Wang X-N, Wang B-G, Zhang L, Liang H. Characteristics and prognosis of gastric cancer in patients aged ≥ 70 years. World J Gastroenterol. 2013;19(39):6568.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Song P, Wu L, Jiang B, Liu Z, Cao K, Guan W. Age-specific effects on the prognosis after surgery for gastric cancer: a SEER population-based analysis. Oncotarget. 2016;7(30):48614–24.

    PubMed  PubMed Central  Google Scholar 

  7. Kim Y, Spolverato G, Ejaz A, Squires MH, Poultsides G, Fields RC, Bloomston M, Weber SM, Votanopoulos K, Acher AW, Jin LX, Hawkins WG, Schmidt C, Kooby D, Worhunsky D, Saunders N, Levine EA, Cho CS, Maithel SK, Pawlik TM. A nomogram to predict overall survival and disease-free survival after curative resection of gastric adenocarcinoma. Ann Surg Oncol. 2015;22(6):1828–35.

    Article  PubMed  Google Scholar 

  8. Han D-S, Suh Y-S, Kong S-H, Lee H-J, Choi Y, Aikou S, Sano T, Park B-J, Kim W-H, Yang H-K. Nomogram predicting long-term survival after d2 gastrectomy for gastric cancer. J Clin Oncol. 2012;30(31):3834–40.

    Article  PubMed  Google Scholar 

  9. Muneoka Y, Akazawa K, Ishikawa T, Ichikawa H, Nashimoto A, Yabusaki H, Tanaka N, Kosugi S-I, Wakai T. Nomogram for 5-year relapse-free survival of a patient with advanced gastric cancer after surgery. Int J Surg. 2016;35:153–9.

    Article  PubMed  Google Scholar 

  10. Schlesinger-Raab A, Mihaljevic AL, Egert S, Emeny R, Jauch K-W, Kleeff J, Novotny A, Nüssler NC, Rottmann M, Schepp W, Schmitt W, Schubert-Fritschle G, Weber B, Schuhmacher C, Engel J. Outcome of gastric cancer in the elderly: a population-based evaluation of the Munich Cancer Registry. Gastric Cancer. 2016;19(3):713–22.

    Article  PubMed  Google Scholar 

  11. Konishi H, Ichikawa D, Itoh H, Fukuda K, Kakihara N, Takemura M, Okugawa K, Uchiyama K, Nakata M, Nishi H, Kosuga T, Komatsu S, Okamoto K, Otsuji E. Surgery for gastric cancer patients of age 85 and older: multicenter survey. World J Gastroenterol. 2017;23(7):1215.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Saif MW, Makrilia N, Zalonis A, Merikas M, Syrigos K. Gastric cancer in the elderly: an overview. Eur J Surg Oncol. 2010;36(8):709–17.

    Article  PubMed  CAS  Google Scholar 

  13. Schwarz RE, Smith DD. Clinical impact of lymphadenectomy extent in resectable gastric cancer of advanced stage. Ann Surg Oncol. 2007;14(2):317–28.

    Article  PubMed  Google Scholar 

  14. Sun DS, Jeon EK, Won HS, Park JC, Shim BY, Park SY, Hong YS, Kim HK, Ko YH. Outcomes in elderly patients treated with a single-agent or combination regimen as first-line chemotherapy for recurrent or metastatic gastric cancer. Gastric Cancer. 2015;18(3):644–52.

    Article  PubMed  CAS  Google Scholar 

  15. Desai AM, Lichtman SM. Systemic therapy of non-colorectal gastrointestinal malignancies in the elderly. Cancer Biol Med. 2015;12(4):284–91.

    PubMed  PubMed Central  CAS  Google Scholar 

  16. Kwon IG, Cho I, Guner A, Kim H, Noh SH, Hyung WJ. Minimally invasive surgery as a treatment option for gastric cancer in the elderly: comparison with open surgery for patients 80 years and older. Surg Endosc. 2015;29(8):2321–30.

    Article  PubMed  Google Scholar 

  17. Ruspi L, Galli F, Pappalardo V, Inversini D, Martignoni F, Boni L, Dionigi G, Rausei S. “Lymphadenectomy in elderly/high risk patients: should it be different?”. Transl Gastroenterol Hepatol. 2017;2:5.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Orsenigo E, Tomajer V, Di Palo S, Carlucci M, Vignali A, Tamburini A, Staudacher C. Impact of age on postoperative outcomes in 1118 gastric cancer patients undergoing surgical treatment. Gastric Cancer. 2007;10(1):39–44.

    Article  PubMed  Google Scholar 

  19. Eguchi T, Fujii M, Takayama T. Mortality for gastric cancer in elderly patients. J Surg Oncol. 2003;84(3):132–6.

    Article  PubMed  Google Scholar 

  20. Ueno D, Matsumoto H, Kubota H, Higashida M, Akiyama T, Shiotani A, Hirai T. Prognostic factors for gastrectomy in elderly patients with gastric cancer. World J Surg Oncol. 2017;15(1):59.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Saidi RF, Bell JL, Dudrick PS. Surgical resection for gastric cancer in elderly patients: is there a difference in outcome? J Surg Res. 2004;118(1):15–20.

    Article  PubMed  Google Scholar 

  22. Pisanu A, Montisci A, Piu S, Uccheddu A. Curative surgery for gastric cancer in the elderly: treatment decisions, surgical morbidity, mortality, prognosis and quality of life. Tumori. 2007;93(5):478–84.

    Article  PubMed  Google Scholar 

  23. Kim MS, Kim S. Outcome of gastric cancer surgery in elderly patients. J Gastric Cancer. 2016;16(4):254–9.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Pak LM, Wang J. The appropriate treatment for elderly gastric cancer patients. Art Surg. 2017;1:4.

    Article  Google Scholar 

Download references

Funding

This research did not receive any specific Grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Medical Oncology Unit, Clinical and Molecular Medicine Department, S Andrea Hospital, Sapienza University of Rome, Rome, Italy

    Michela Roberto, Andrea Botticelli, Concetta Elisa Onesti, Rosa Falcone, Federica Mazzuca & Paolo Marchetti

  2. Laboratory of Medical Physics and Expert Systems, Reginal Elena National Cancer Institute, Rome, Italy

    Lidia Strigari

  3. Oncology Unit, Oncology Department, ASST of Cremona, Hospital of Cremona, Cremona, Italy

    Michele Ghidini, Margherita Ratti, Claudio Pizzo & Bianca Maria Donida

  4. General Surgery Unit, Surgical Department, ASST of Cremona, Hospital of Cremona, Cremona, Italy

    Ilaria Benzoni, Daniele Lomiento & Luigi Totaro

Authors
  1. Michela Roberto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrea Botticelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lidia Strigari
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michele Ghidini
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Concetta Elisa Onesti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Margherita Ratti
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ilaria Benzoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Claudio Pizzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Rosa Falcone
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Daniele Lomiento
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Bianca Maria Donida
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Luigi Totaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Federica Mazzuca
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Paolo Marchetti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michela Roberto.

Ethics declarations

Conflict of interest

The authors report no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Roberto, M., Botticelli, A., Strigari, L. et al. Prognosis of elderly gastric cancer patients after surgery: a nomogram to predict survival. Med Oncol 35, 111 (2018). https://doi.org/10.1007/s12032-018-1166-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12032-018-1166-8

Keywords

Search

Navigation