Prognostic Factors in Patients Aged ≥80 Years With Stage II-III Gastric Cancer

The number of elderly patients with gastric cancer (GC) is increasing in aging societies. However, the optimal surgical strategy for patients aged ≥80 years with advanced gastric cancer remains unclear because these patients often have frailty, sarcopenia, and multiple comorbidities. This study aimed to identify prognostic factors in patients aged ≥80 years with stage II-III GC who underwent gastrectomy.

This retrospective study included 57 patients aged ≥80 years with pathological stage II-III gastric cancer who underwent curative gastrectomy between January 2013 and March 2023. We evaluated clinicopathological factors, nutritional indices (PNI, CONUT score, GNRI, and skeletal muscle index), surgical factors, and postoperative outcomes. Overall survival (OS) and cancer-specific survival (CSS) were analyzed using the Kaplan-Meier method and compared using the log-rank test. Prognostic factors were evaluated using the Cox proportional hazards model.

The median age was 83 years (range=80-93 years). Distal gastrectomy was performed in 43 patients, proximal gastrectomy in six, and total gastrectomy (TG) in eight. Severe postoperative complications (Clavien-Dindo ≥3) occurred in nine patients (15.8%). Univariate analysis identified BMI <18, CONUT score ≥5, TG, and severe postoperative complications as significant predictors of poor OS. TG was the only independent prognostic factor (hazard ratio=3.48; 95% confidence interval=1.20-10.1; p=0.0218), according to multivariate analysis. Kaplan-Meier analysis showed significantly worse OS in the TG group than in the nonTG group, while no significant difference in the CSS was observed.

Total gastrectomy was an independent predictor of poor OS in patients aged ≥80 years with stage II-III GC. These findings suggest that patient-related factors and surgical extent may influence the prognosis of very elderly patients.