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Prediction of survival benefit when deciding between chemotherapy and best supportive therapy in elderly patients with advanced gastric cancer: A retrospective cohort study

It remains unclear whether elderly patients (EPs) with advanced gastric cancer (AGC) benefit from chemotherapy. The aim of the present study was to examine the prognostic factors for EPs with AGC in order to generate a prognosis-predicting scoring system. This single-center retrospective study exami...

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Autores principales: Sugimoto, Aya, Nishida, Tsutomu, Osugi, Naoto, Takahashi, Kei, Mukai, Kaori, Nakamatsu, Dai, Matsubara, Tokuhiro, Hayashi, Shiro, Yamamoto, Masashi, Nakajima, Sachiko, Fukui, Koji, Inada, Masami
Formato: Online Artículo Texto
Lenguaje:English
Publicado: D.A. Spandidos 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313942/
https://www.ncbi.nlm.nih.gov/pubmed/30655981
http://dx.doi.org/10.3892/mco.2018.1772
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author Sugimoto, Aya
Nishida, Tsutomu
Osugi, Naoto
Takahashi, Kei
Mukai, Kaori
Nakamatsu, Dai
Matsubara, Tokuhiro
Hayashi, Shiro
Yamamoto, Masashi
Nakajima, Sachiko
Fukui, Koji
Inada, Masami
author_facet Sugimoto, Aya
Nishida, Tsutomu
Osugi, Naoto
Takahashi, Kei
Mukai, Kaori
Nakamatsu, Dai
Matsubara, Tokuhiro
Hayashi, Shiro
Yamamoto, Masashi
Nakajima, Sachiko
Fukui, Koji
Inada, Masami
author_sort Sugimoto, Aya
collection PubMed
description It remains unclear whether elderly patients (EPs) with advanced gastric cancer (AGC) benefit from chemotherapy. The aim of the present study was to examine the prognostic factors for EPs with AGC in order to generate a prognosis-predicting scoring system. This single-center retrospective study examined consecutive patients with AGC between April 2012 and July 2017. Risk factors for survival in EPs aged ≥75 years were identified using a Cox proportional hazards model, and a prognostic scoring system was generated and retrospectively evaluated to determine its usefulness for predicting patient prognosis. A total of 61 patients were enrolled as EPs (mean age, 81 years) and compared with 80 non-EPs (mean age, 66 years). The median survival time (MST) was significantly longer for non-EPs compared with that for EPs (3.8 vs. 10.1 months, respectively; P=0.0447). Among the EPs, 29 (48%) received chemotherapy and 32 received best supportive care (BSC). A total of 68 non-EPs (85%) received chemotherapy and 12 non-EPs received BSC. Among EPs with AGC, age-adjusted multivariate analysis revealed that performance status (PS), neutrophil/lymphocyte ratio (NLR)<4, intestinal-type histology and chemotherapy were significant prognostic factors. To predict EPs too frail for chemotherapy prior to treatment, one point was assigned for a PS of 1, diffuse-type histology and NLR≥4, whereas 2 points were assigned for PS≥2, and the point totals for each patient were calculated. A cut-off point of 2 had the best P-value by the log-rank test and was used to divide the patients into low-risk (LoR: Score 0–1) and high-risk (HiR: Score 2–4) groups. The MST of the LoR and HiR groups was 23.6 and 3.6 months, respectively (P<0.001). As regards treatment strategies and risk groups, the LoR chemotherapy group had the best prognosis (P=0.0010), and LoR EPs who were administered chemotherapy had a longer MST (30.3 months) compared with EPs who received BSC (8.7 months). In conclusion, scoring systems using PS, histology and NLR may be useful when considering chemotherapy in EPs with AGC.
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spelling pubmed-63139422019-01-17 Prediction of survival benefit when deciding between chemotherapy and best supportive therapy in elderly patients with advanced gastric cancer: A retrospective cohort study Sugimoto, Aya Nishida, Tsutomu Osugi, Naoto Takahashi, Kei Mukai, Kaori Nakamatsu, Dai Matsubara, Tokuhiro Hayashi, Shiro Yamamoto, Masashi Nakajima, Sachiko Fukui, Koji Inada, Masami Mol Clin Oncol Articles It remains unclear whether elderly patients (EPs) with advanced gastric cancer (AGC) benefit from chemotherapy. The aim of the present study was to examine the prognostic factors for EPs with AGC in order to generate a prognosis-predicting scoring system. This single-center retrospective study examined consecutive patients with AGC between April 2012 and July 2017. Risk factors for survival in EPs aged ≥75 years were identified using a Cox proportional hazards model, and a prognostic scoring system was generated and retrospectively evaluated to determine its usefulness for predicting patient prognosis. A total of 61 patients were enrolled as EPs (mean age, 81 years) and compared with 80 non-EPs (mean age, 66 years). The median survival time (MST) was significantly longer for non-EPs compared with that for EPs (3.8 vs. 10.1 months, respectively; P=0.0447). Among the EPs, 29 (48%) received chemotherapy and 32 received best supportive care (BSC). A total of 68 non-EPs (85%) received chemotherapy and 12 non-EPs received BSC. Among EPs with AGC, age-adjusted multivariate analysis revealed that performance status (PS), neutrophil/lymphocyte ratio (NLR)<4, intestinal-type histology and chemotherapy were significant prognostic factors. To predict EPs too frail for chemotherapy prior to treatment, one point was assigned for a PS of 1, diffuse-type histology and NLR≥4, whereas 2 points were assigned for PS≥2, and the point totals for each patient were calculated. A cut-off point of 2 had the best P-value by the log-rank test and was used to divide the patients into low-risk (LoR: Score 0–1) and high-risk (HiR: Score 2–4) groups. The MST of the LoR and HiR groups was 23.6 and 3.6 months, respectively (P<0.001). As regards treatment strategies and risk groups, the LoR chemotherapy group had the best prognosis (P=0.0010), and LoR EPs who were administered chemotherapy had a longer MST (30.3 months) compared with EPs who received BSC (8.7 months). In conclusion, scoring systems using PS, histology and NLR may be useful when considering chemotherapy in EPs with AGC. D.A. Spandidos 2019-01 2018-11-19 /pmc/articles/PMC6313942/ /pubmed/30655981 http://dx.doi.org/10.3892/mco.2018.1772 Text en Copyright: © Sugimoto et al. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License (https://creativecommons.org/licenses/by-nc-nd/4.0/) , which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
spellingShingle Articles
Sugimoto, Aya
Nishida, Tsutomu
Osugi, Naoto
Takahashi, Kei
Mukai, Kaori
Nakamatsu, Dai
Matsubara, Tokuhiro
Hayashi, Shiro
Yamamoto, Masashi
Nakajima, Sachiko
Fukui, Koji
Inada, Masami
Prediction of survival benefit when deciding between chemotherapy and best supportive therapy in elderly patients with advanced gastric cancer: A retrospective cohort study
title Prediction of survival benefit when deciding between chemotherapy and best supportive therapy in elderly patients with advanced gastric cancer: A retrospective cohort study
title_full Prediction of survival benefit when deciding between chemotherapy and best supportive therapy in elderly patients with advanced gastric cancer: A retrospective cohort study
title_fullStr Prediction of survival benefit when deciding between chemotherapy and best supportive therapy in elderly patients with advanced gastric cancer: A retrospective cohort study
title_full_unstemmed Prediction of survival benefit when deciding between chemotherapy and best supportive therapy in elderly patients with advanced gastric cancer: A retrospective cohort study
title_short Prediction of survival benefit when deciding between chemotherapy and best supportive therapy in elderly patients with advanced gastric cancer: A retrospective cohort study
title_sort prediction of survival benefit when deciding between chemotherapy and best supportive therapy in elderly patients with advanced gastric cancer: a retrospective cohort study
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313942/
https://www.ncbi.nlm.nih.gov/pubmed/30655981
http://dx.doi.org/10.3892/mco.2018.1772
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