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Gastric Cancer

, Volume 22, Issue 4, pp 838–844 | Cite as

Long-term outcomes and prognostic factors with non-curative endoscopic submucosal dissection for gastric cancer in elderly patients aged ≥ 75 years

  • Yosuke ToyaEmail author
  • Masaki Endo
  • Shotaro Nakamura
  • Risaburo Akasaka
  • Shunichi Yanai
  • Keisuke Kawasaki
  • Keisuke Koeda
  • Makoto Eizuka
  • Yasuko Fujita
  • Noriyuki Uesugi
  • Kazuyuki Ishida
  • Tamotsu Sugai
  • Takayuki Matsumoto
Original Article

Abstract

Background

Little is known about the long-term outcomes and prognostic factors with non-curative endoscopic submucosal dissection (ESD) in elderly patients with early gastric cancer.

Methods

Clinicopathological findings and long-term outcomes were evaluated in 87 patients with early gastric cancer (EGC) aged ≥ 75 years who were treated with non-curative ESD. Prognostic factors for overall survival (OS) were analyzed with the Kaplan–Meier method and a Cox proportional hazards model.

Results

During the follow-up period, among 27 patients who died of any cause, only one patient died of gastric cancer. OS probabilities after 3 and 5 years were 89.7% and 79.3%, respectively. Univariate analyses revealed that Eastern Cooperative Oncology Group performance status 2–3, Charlson comorbidity index (CCI) ≥ 3, neutrophil/lymphocyte ratio ≥ 3.3, prognostic nutritional index < 44.8, distal tumor location and macroscopically depressed or flat configuration were associated with poor OS. Cox multivariate analysis revealed high CCI (≥ 3) to be an independent prognostic factor associated with OS (hazard ratio: 2.63, 95% confidence interval [CI] 1.06–6.49, P = 0.037).

Conclusions

CCI may be a useful parameter for decision-making regarding additional surgery for elderly patients with gastric cancer treated by non-curative ESD.

Keywords

Gastric cancer Elderly patients Prognostic factors Charlson comorbidity index 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have conflict of interest.

Ethical approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. The exemption from informed consent requirement was permitted by Iwate Medical University Institutional Review Board.

References

  1. 1.
    Kosaka T, Endo M, Toya Y, et al. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a single-center retrospective study. Dig Endosc. 2014;26:183–91.CrossRefGoogle Scholar
  2. 2.
    Isomoto H, Shikuwa S, Yamaguchi N, et al. Endoscopic submucosal dissection for early gastric cancer: a large-scale feasibility study. Gut. 2009;58:331–6.CrossRefGoogle Scholar
  3. 3.
    Toyonaga T, Man-i M, East JE, et al. 1,635 Endoscopic submucosal dissection cases in the esophagus, stomach, and colorectum: complication rates and long-term outcomes. Surg Endosc. 2013;27:1000–8.CrossRefGoogle Scholar
  4. 4.
    Oda I, Oyama T, Abe S, et al. Preliminary results of multicenter questionnaire study on long-term outcomes of curative endoscopic submucosal dissection for early gastric cancer. Dig Endosc. 2014;26:214–9.CrossRefGoogle Scholar
  5. 5.
    Tanabe S, Ishido K, Matsumoto T, et al. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a multicenter collaborative study. Gastric Cancer. 2017;20:45–52.CrossRefGoogle Scholar
  6. 6.
    Cho JH, Cha SW, Kim HG, et al. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a comparison study to surgery using propensity score-matched analysis. Surg Endosc. 2016;30:3762–73.CrossRefGoogle Scholar
  7. 7.
    Park CH, Lee H, Kim D, et al. Clinical safety of endoscopic submucosal dissection compared with surgery in elderly patients with early gastric cancer: a propensity-matched analysis. Gastrointest Endosc. 2014;80:599–609.CrossRefGoogle Scholar
  8. 8.
    Kakusima N, Fujishiro M, Kodashima S, et al. Technical feasibility of endoscopic submucosal dissection for gastric neoplasms in the elderly Japanese population. J Gastroenterol Hepatol. 2007;22:311–4.CrossRefGoogle Scholar
  9. 9.
    Abe N, Gotoda T, Hirasawa T, et al. Multicenter study of the long-term out comes of endoscopic submucosal dissection for early gastric cancer in patients 80 years of age or older. Gastric Cancer. 2011;15:70–5.CrossRefGoogle Scholar
  10. 10.
    Yoshifuku Y, Oka S, Tanaka S, et al. Long-term prognosis after endoscopic submucosal dissection for early gastric cancer in super-elderly patients. Surg Endosc. 2016;30:4321–9.CrossRefGoogle Scholar
  11. 11.
    Kato M, Michida T, Kusakabe A, et al. Safety and short-term outcomes of endoscopic submucosal dissection for early gastric cancer in elderly patients. Endosc Int Open. 2016;4:E521–6.CrossRefGoogle Scholar
  12. 12.
    Watanabe K, Hikichi T, Nakamura J, et al. Endoscopic submucosal dissection for early gastric cancer in very elderly patients age 85 or older. Endosc Int Open. 2017;5:E17–24.CrossRefGoogle Scholar
  13. 13.
    Sumiyoshi T, Kondo H, Fujii R, et al. Short- and long-term outcomes of endoscopic submucosal dissection for early gastric cancer in elderly patients aged 75 years and older. Gastric Cancer. 2017;20:489–95.CrossRefGoogle Scholar
  14. 14.
    Sekiguchi M, Oda I, Suzuki H, et al. Clinical outcomes and prognostic factors in gastric cancer patients aged ≥ 85 years undergoing endoscopic submucosal dissection. Gastrointest Endosc. 2017;85:963–72.CrossRefGoogle Scholar
  15. 15.
    Oda I, Gotoda T, Sasako M, et al. Treatment strategy after non-curative endoscopic resection of early gastric cancer. Br J Surg. 2008;95:1495–500.CrossRefGoogle Scholar
  16. 16.
    Kang MS, Hong SJ, Kim DY, et al. Long-term outcome after endoscopic submucosal dissection for early gastric cancer: focusing on a group beyond the expanded indication. J Dig Dis. 2015;16:7–13.CrossRefGoogle Scholar
  17. 17.
    Hoteya S, Iizuka T, Kikuchi D, et al. Clinicopathological outcomes of patients with early gastric cancer after non-curative endoscopic submucosal dissection. Digestion. 2016;93:53–8.CrossRefGoogle Scholar
  18. 18.
    Toya Y, Endo M, Nakamura S, et al. Clinical outcomes of non-curative endoscopic submucosal dissection with negative resected margins for gastric cancer. Gastrointest Endosc. 2017;85:1218–24.CrossRefGoogle Scholar
  19. 19.
    Hatta W, Gotoda T, Oyama T, et al. Is radical surgery necessary in all patients who do not meet the curative criteria for endoscopic submucosal dissection in early gastric cancer? A multi-center retrospective study in Japan. J Gastroenterol. 2017;52:175–84.CrossRefGoogle Scholar
  20. 20.
    Oken MM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol. 1982;5:649–55.CrossRefGoogle Scholar
  21. 21.
    Bouillanne O, Morineau G, Dupont C, et al. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am L Clin Nutr. 2005;82:777–83.CrossRefGoogle Scholar
  22. 22.
    Yamada K, Furuya R, Takita T, et al. Simplified nutritional screening tools for patients on maintenance hemodialysis. Am J Clin Nutr. 2008;87:106–13.CrossRefGoogle Scholar
  23. 23.
    Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.CrossRefGoogle Scholar
  24. 24.
    Hirashima M, Higuchi S, Sakamoto K, et al. The ratio of neutrophils to lymphocytes and the phenotypes of neutrophils in patients with early gastric cancer. J Cancer Res Clin Oncol. 1998;124:329–4.CrossRefGoogle Scholar
  25. 25.
    Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients [in Japanese with an English abstract]. Nihon Geka Gakkai Zasshi. 1984;85:1001–5.Google Scholar
  26. 26.
    Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver.4). Gastric Cancer. 2017;1:1–19.CrossRefGoogle Scholar
  27. 27.
    Ono H, Yao K, Fujishiro M, et al. Guidelines for endoscopic submucosal dissection and endoscopic mucosal resection for early gastric cancer. Dig Endosc. 2016;28:3–15.CrossRefGoogle Scholar
  28. 28.
    Huang Y, Chen W, Haque W, et al. The impact of comorbidity on overall survival in elderly nasopharyngeal carcinoma patients: a National Cancer Data Base analysis. Cancer Med. 2018;7:1093–101 (Epub ahead of print).CrossRefGoogle Scholar
  29. 29.
    Yamashita K, Watanabe M, Mine S, et al. The impact of the Charlson comorbidity index on the prognosis of esophageal cancer patients who underwent esophagectomy with curative intent. Surg Today. 2018;6:632–39 (Epub ahead of print).CrossRefGoogle Scholar
  30. 30.
    Tominaga T, Nonaka T, Takeshita H, et al. The Charlson comorbidity index as an independent prognostic factor in older colorectal cancer patients. Indian J Surg. 2018;80:54–60.CrossRefGoogle Scholar
  31. 31.
    Huang CM, Tu RH, Lin JX, et al. A scoring system to predict the risk of postoperative complications after laparoscopic gastrectomy for gastric cancer based on a large-scale retrospective study. Medicine. 2015;94:e812.CrossRefGoogle Scholar
  32. 32.
    Fujisaki M, Shinohara T, Hanyu N, et al. Laparoscopic gastrectomy for gastric cancer in the elderly patients. Surg Endosc. 2016;30:1380–7.CrossRefGoogle Scholar
  33. 33.
    Iwai N, Dohi O, Naito Y, et al. Impact of the Charlson comorbidity index and prognostic nutritional index on prognosis in patients with early gastric cancer after endoscopic submucosal dissection. Dig Endosc. 2018;30:616–23.CrossRefGoogle Scholar
  34. 34.
    Kusano C, Iwasaki M, Kaltenbach T, et al. Should elderly patients undergo additional surgery after non-curative endoscopic resection for early gastric cancer? Long-term comparative outcomes. Am J Gastroenterol. 2011;106:1064–9.CrossRefGoogle Scholar
  35. 35.
    Hatta W, Gotoda T, Oyama T, et al. A scoring system of stratify curability after endoscopic submucosal dissection for early gastric cancer; “eCura system”. Am J Gastroenterol. 2017;112:874–81.CrossRefGoogle Scholar
  36. 36.
    Hatta W, Gotoda T, Oyama T, et al. Is the e Cura system useful for selecting patients who require radical surgery after noncurative endoscopic submucosal dissection for early gastric cancer? A comparative study. Gastric Cancer. 2018;21:481–9.CrossRefGoogle Scholar

Copyright information

© The International Gastric Cancer Association and The Japanese Gastric Cancer Association 2018

Authors and Affiliations

  • Yosuke Toya
    • 1
    Email author
  • Masaki Endo
    • 1
    • 2
  • Shotaro Nakamura
    • 1
  • Risaburo Akasaka
    • 1
  • Shunichi Yanai
    • 1
  • Keisuke Kawasaki
    • 1
  • Keisuke Koeda
    • 3
  • Makoto Eizuka
    • 4
  • Yasuko Fujita
    • 4
  • Noriyuki Uesugi
    • 4
  • Kazuyuki Ishida
    • 4
  • Tamotsu Sugai
    • 4
  • Takayuki Matsumoto
    • 1
  1. 1.Division of Gastroenterology, Department of Internal Medicine, School of MedicineIwate Medical UniversityMoriokaJapan
  2. 2.Kaiunbashi Endoscopy ClinicMoriokaJapan
  3. 3.Department of Surgery, School of MedicineIwate Medical UniversityMoriokaJapan
  4. 4.Division of Molecular Diagnostic Pathology, Department of Pathology, School of MedicineIwate Medical UniversityMoriokaJapan

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