Treatment strategy after noncurative endoscopic resection for early gastric cancers in patients aged ≥ 85 years: a multicenter retrospective study in a highly aged area of Japan.

Autor: Hatta W; Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan. waku-style@festa.ocn.ne.jp., Toya Y; Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba, Japan., Shimada T; Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan., Hamada K; Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima, Japan., Watanabe K; Department of Gastroenterology, Ohara General Hospital, Fukushima, Japan., Nakamura J; Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan., Fukushi D; Division of Gastroenterology Tohoku Medical and Pharmaceutical University, Sendai, Japan., Koike T; Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan., Shinkai H; Department of Gastroenterology, Iwate Prefectural Isawa Hospital, Oshu, Japan., Ito H; Department of Gastroenterology, Osaki Citizen Hospital, Osaki, Japan., Matsuhashi T; Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan., Fujimori S; Department of Gastroenterology, Yokote Municipal Hospital, Yokote, Japan., Iwai W; Department of Gastroenterology, Miyagi Cancer Center, Natori, Japan., Hanabata N; Division of Endoscopy, Aomori Prefectural Central Hospital, Aomori, Japan., Shiroki T; Department of Gastroenterology, Iwate Prefectural Central Hospital, Morioka, Japan., Sasaki Y; Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata, Japan., Fujishima Y; Division of Gastroenterology, Noshiro Kosei Medical Center, Noshiro, Japan., Tsuji T; Department of Gastroenterology, Akita City Hospital, Akita, Japan., Yorozu H; Digestive Disease Center, Akita Red Cross Hospital, Akita, Japan., Yoshimura T; Division of Gastroenterology, Aomori City Hospital, Aomori, Japan., Horikawa Y; Department of Gastroenterology, Hiraka General Hospital, Yokote, Japan., Takahashi Y; Department of Gastroenterology, National Hospital Organization Sendai Medical Center, Sendai, Japan., Takahashi H; Department of Gastroenterology, Iwate Prefectural Ninohe Hospital, Ninohe, Japan., Kondo Y; Division of Gastroenterology, Tohoku Rosai Hospital, Sendai, Japan., Fujiwara T; Department of Gastroenterology, Japanese Red Cross Morioka Hospital, Morioka, Japan., Mizugai H; Department of Gastroenterology, Hachinohe Red Cross Hospital, Hachinohe, Japan., Gonai T; Department of Gastroenterology, Iwate Prefectural Kuji Hospital, Kuji, Japan., Tatsuta T; Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan., Onochi K; Department of Gastroenterology, Omagari Kosei Medical Center, Daisen, Japan., Kudara N; Department of Internal Medicine and Gastroenterology, Iwate Prefectural Ofunato Hospital, Ofunato, Japan., Abe K; Department of Gastroenterology, Iwate Prefectural Miyako Hospital, Miyako, Japan., Ogata Y; Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan., Ohira T; Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan., Horikawa Y; Department of Gastroenterology, Southern-Tohoku General Hospital, Fukushima, Japan., Ishihata R; Department of Gastroenterology, Ohara General Hospital, Fukushima, Japan., Hikichi T; Department of Endoscopy, Fukushima Medical University Hospital, Fukushima, Japan., Satoh K; Division of Gastroenterology Tohoku Medical and Pharmaceutical University, Sendai, Japan., Iijima K; Department of Gastroenterology and Neurology, Akita University Graduate School of Medicine, Akita, Japan., Fukuda S; Department of Gastroenterology and Hematology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan., Matsumoto T; Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Yahaba, Japan., Masamune A; Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-Machi, Aoba-Ku, Sendai, Miyagi, 980-8574, Japan.
Jazyk: angličtina
Zdroj: Journal of gastroenterology [J Gastroenterol] 2023 Apr; Vol. 58 (4), pp. 346-357. Date of Electronic Publication: 2023 Jan 12.
DOI: 10.1007/s00535-022-01948-7
Abstrakt: Background: The guidelines recommend additional gastrectomy after noncurative endoscopic resection for early gastric cancers (EGCs). However, no additional treatment might be acceptable in some patients aged ≥ 85 years. We aimed to identify this patient group using the data in a highly aged area.
Methods: We enrolled patients aged ≥ 85 years after noncurative endoscopic resection for EGCs at 30 institutions of the Tohoku district in Japan between 2002 and 2017. Treatment selection and prognosis after noncurative endoscopic resection were investigated. Fourteen candidates were evaluated using the Cox model to identify risk factors for poor overall survival (OS) in patients with no additional treatment.
Results: Of 1065 patients aged ≥ 85 years, 143 underwent noncurative endoscopic resection. Despite the guidelines' recommendation, 88.8% of them underwent no additional treatment. The 5-year OS rates in those with additional gastrectomy and those with no additional treatment were 63.1 and 65.2%, respectively. Multivariate analysis showed independent risk factors for poor OS in patients with no additional treatment were the high-risk category in the eCura system (hazard ratio [HR], 2.91), Charlson comorbidity index (CCI) ≥ 3 (HR, 2.78), and male (HR, 2.04). In patients with no additional treatment, nongastric cancer-specific survival was low (69.0% in 5 years), whereas disease-specific survival rates were very high in the low- and intermediate-risk categories of the eCura system (100.0 and 97.1%, respectively, in 5 years).
Conclusions: No additional treatment may be acceptable in the low- and intermediate-risk categories of the eCura system in patients aged ≥ 85 years with noncurative endoscopic resection for EGCs.
(© 2023. Japanese Society of Gastroenterology.)
Databáze: MEDLINE
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