Skip to main content

Advertisement

SpringerLink
Log in

Advanced or metastatic gastric cancer in elderly patients: clinicopathological, prognostic factors and treatments

  • Research Article
  • Published:
Clinical and Translational Oncology Aims and scope Submit manuscript

Abstract

Purpose

To analyze the clinicopathological features, prognostic factors, treatment efficacy and safety among elderly patients with advanced or metastatic gastric cancer.

Methods

Three hundred and nineteen patients aged 65 years and older, diagnosed with advanced or metastatic gastric cancer, were followed and data were retrospectively collected, reviewed and analyzed.

Results

The elderly patients carried specific clinicopathological characteristics. Body mass index (BMI), number of metastatic lesions, ascites, Karnofsky performance score (KPS), tumor differentiation grade, lactate dehydrogenase (LDH) level, local treatment, and chemotherapy were the independent prognostic factors. Serum LDH level was superior to the serum CEA level in the prognosis of advanced or metastatic gastric cancer in older patients. Cisplatin-based regimen, chemotherapy cycles, metastatic lesions, LDH level, and supraclavicular lymph node metastasis were the independent prognostic factors in 220 patients receiving chemotherapy. The toxicity was mild and tolerable.

Conclusion

KPS, BMI and a well-differentiated histopathology were factors favoring longer survival, whereas elevated serum LDH and a greater number of metastatic lesions were associated with poor prognosis among those elderly patients. Cisplatin-based chemotherapy provided survival benefits and mild toxicity.

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

Similar content being viewed by others

Abbreviations

BMI:

Body mass index

CEA:

Carcinoembryonic antigen

CR:

Complete response

5-FU:

5-Fluorouracil

HR:

Hazards ratio

KPS:

Karnofsky performance score

LDH:

Lactate dehydrogenase

PR:

Partial response

SD:

Stable disease

TTP:

Time to progression

References

  1. Munoz N, Franceschi S (1997) Epidemiology of gastric cancer and perspectives for prevention. Salud Publica Mex 39:318–330

    PubMed  CAS  Google Scholar 

  2. Kamangar F, Dores GM, Anderson WF (2006) Patterns of cancer incidence, mortality, and prevalence across five continents: defining priorities to reduce cancer disparities in different geographic regions of the world. J Clin Oncol 24:2137–2150

    Article  PubMed  Google Scholar 

  3. Bruckner HW, Morris JC, Mansfield P (2000) Neoplasms of the stomach. In: Cancer medicine, 5th edn. BC Decker, Hamilton, pp 1355–1390

  4. Wu CX, Zheng Y, Bao PP et al (2008) Pattern of changing incidence of gastric cancer and its time trend in Shanghai. J Surg Concerpts Pract 13:24–29

    Google Scholar 

  5. Arai T, Takubo K (2007) Clinicopathological and molecular characteristics of gastric and colorectal carcinomas in the elderly. Pathol Int 57:303–314

    Article  PubMed  CAS  Google Scholar 

  6. Cascinu S, Labianca R, Alessandroni P et al (1997) Intensive weekly chemotherapy for advanced gastric cancer using fluorouracil, cisplatin, epi-doxorubicin, 6S-leucovorin, glutathione, and filgrastim: a report from the Italian Group for the Study of Digestive Tract Cancer. J Clin Oncol 15:3313–3319

    PubMed  CAS  Google Scholar 

  7. Cascinu S, Scartozzi M, Labianca R et al (2004) High curative resection rate with weekly cisplatin, 5-fluorouracil, epidoxorubicin, 6S-leucovorin, glutathione, and filgastrim in patients with locally advanced, unresectable gastric cancer: a report from the Italian Group for the Study of Digestive Tract Cancer [GISCAD]. Br J Cancer 8:1521–1525

    Article  Google Scholar 

  8. Habu H, Endo M (1989) Gastric cancer in elderly patients: results of surgical treatment. Hepatogastroenterology 36:71–74

    PubMed  CAS  Google Scholar 

  9. Fujimoto S, Takahashi M, Ohkubo H et al (1994) Comparative clinicopathologic features of early gastric cancer in young and older patients. Surgery 115:516–520

    PubMed  CAS  Google Scholar 

  10. Wang JY, Hsieh JS, Huang CJ et al (1996) Clinicopathologic study of advanced gastric cancer without serosal invasion in young and old patients. J Surg Oncol 63:36–40

    Article  PubMed  CAS  Google Scholar 

  11. Saif MW, Makrilia N, Zalonis A et al (2010) Gastric cancer in the elderly: an overview. Eur J Surg Oncol 36:709–717

    Article  PubMed  CAS  Google Scholar 

  12. Arai T, Esaki Y, Inoshita N et al (2004) Pathologic characteristics of gastric cancer in the elderly: a retrospective study of 994 surgical patients. Gastric Cancer 7:154–159

    Article  PubMed  Google Scholar 

  13. Ishigami S, Natsugoe S, Saihara T et al (1997) Clinical and pathologic features of early gastric cancer in elderly patients. Hepatogastroenterology 44:1164–1168

    PubMed  CAS  Google Scholar 

  14. Inoshita N, Yanagisawa A, Arai T et al (1998) Pathological characteristics of gastric carcinomas in the very old. Jpn J Cancer Res 89:1087–1092

    Article  PubMed  CAS  Google Scholar 

  15. Wu CW, Lo SS, Shen KH et al (2000) Surgical mortality, survival and quality of life after resection for gastric cancer in the elderly. World J Surg 24:465–472

    Article  PubMed  CAS  Google Scholar 

  16. Maehara Y, Emi Y, Tomisaki S et al (1996) Age-related characteristics of gastric carcinoma in young and elderly patients. Cancer 77:1774–1780

    Article  PubMed  CAS  Google Scholar 

  17. Nielsen J, Aagaard J, Toftgaard C (1985) Gastric cancer with special reference to prognostic factors: a review of 779 cases. Acta Chir Scand 151:49–55

    PubMed  CAS  Google Scholar 

  18. Chau I, Norman AR, Cunningham D et al (2004) Multivariate prognostic factor analysis in locally advanced and metastatic esophago-gastric cancer-pooled analysis from three multicenter, randomised, controlled trials using individual patient data. J Clin Oncol 22:2395–2403

    Article  PubMed  Google Scholar 

  19. Sudo H, Takagi Y, Katayanagi S et al (2006) Bone metastasis of gastric cancer. Gan To Kagaku Ryoho 33:1058–1060

    PubMed  Google Scholar 

  20. Glimelius B, Ekström K, Hoffman K et al (1997) Randomised comparison between chemotherapy plus best supportive care with best supportive care in advanced gastric cancer. Ann Oncol 8:163–168

    Article  PubMed  CAS  Google Scholar 

  21. Pyrhönen S, Kuitunen T, Nyandoto P et al (1995) Randomised comparison of fluorouracil, epidoxorubicin and methotrexate (FEMTX) plus supportive care with supportive care alone in patients with non-resectable gastric cancer. Br J Cancer 71:587–591

    Article  PubMed  Google Scholar 

  22. Murad AM, Santiago FF, Petroianu A et al (1993) Modified therapy with 5-fluorouracil, doxorubicin, and methotrexate in advanced gastric cancer. Cancer 72:37–41

    Article  PubMed  CAS  Google Scholar 

  23. Trumper M, Ross PJ, Cunningham D et al (2006) Efficacy and tolerability of chemotherapy in elderly patients with advanced oesophago-gastric cancer: a pooled analysis of three clinical trials. Eur J Cancer 42:827–834

    Article  PubMed  CAS  Google Scholar 

  24. Santini D, Graziano F, Catalano V et al (2006) Weekly oxaliplatin, 5-fluorouracil and folinic acid (OXALF) as first-line chemotherapy for elderly patients with advanced gastric cancer: results of a phase II trial. BMC Cancer 6:125

    Article  PubMed  CAS  Google Scholar 

  25. Graziano F, Santini D, Testa E et al (2003) A phase II study of weekly cisplatin, 6S-stereoisomer leucovorin and fluorouracil as first-line chemotherapy for elderly patients with advanced gastric cancer. Br J Cancer 89:1428–1432

    Article  PubMed  CAS  Google Scholar 

  26. Koizumi W, Narahara H, Hara T et al (2008) S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol 9:215–221

    Article  PubMed  CAS  Google Scholar 

  27. Seol YM, Song MK, Choi YJ et al (2009) Oral fluoropyrimidines (capecitabine or S-1) and cisplatin as first line treatment in elderly patients with advanced gastric cancer: a retrospective study. Jpn J Clin Oncol 39:43–48

    Article  PubMed  Google Scholar 

  28. Tsushima T, Hironaka S, Boku N et al (2010) Safety and efficacy of S-1 monotherapy in elderly patients with advanced gastric cancer. Gastric Cancer 13:245–250

    Article  PubMed  CAS  Google Scholar 

  29. Lee JL, Kang YK, Kang HJ et al (2008) A randomised multicentre phase II trial of capecitabine vs S-1 as first-line treatment in elderly patients with metastatic or recurrent unresectable gastric cancer. Br J Cancer 99:584–590

    Article  PubMed  CAS  Google Scholar 

  30. Tsuji A, Shima Y, Morita S et al (2008) Combination chemotherapy of S-1 and low-dose twice-weekly cisplatin for advanced and recurrent gastric cancer in an outpatient setting: a retrospective study. Anticancer Res 28:1433–1438

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This work was supported by the Beijing Municipal Science and Technology Commission Programs “Optimization of pharmacotherapy and individual selection in gastric cancer” (No. D101100050010023) and “Exploring the utilization of molecular markers in the individual treatment of gastric cancer based on the clinical research cohort”.

Conflict of interest

The authors declare that they have no conflict of interest relating to the publication of this manuscript.

Author information

Authors and Affiliations

  1. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of GI Oncology, Beijing Cancer Hospital and Institute, Peking University School of Oncology, Beijing, 100142, China

    Z. Lu, M. Lu, X. Zhang, J. Li, J. Zhou, J. Gong, J. Gao, J. Li, X. Zhang, Y. Li & L. Shen

Authors
  1. Z. Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. X. Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Gong
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Gao
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. X. Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Y. Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. L. Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. Shen.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lu, Z., Lu, M., Zhang, X. et al. Advanced or metastatic gastric cancer in elderly patients: clinicopathological, prognostic factors and treatments. Clin Transl Oncol 15, 376–383 (2013). https://doi.org/10.1007/s12094-012-0938-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12094-012-0938-4

Keywords

Search

Navigation