Open Access

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

  • Authors:
    • Aya Sugimoto
    • Tsutomu Nishida
    • Naoto Osugi
    • Kei Takahashi
    • Kaori Mukai
    • Dai Nakamatsu
    • Tokuhiro Matsubara
    • Shiro Hayashi
    • Masashi Yamamoto
    • Sachiko Nakajima
    • Koji Fukui
    • Masami Inada
  • View Affiliations

  • Published online on: November 19, 2018     https://doi.org/10.3892/mco.2018.1772
  • Pages: 83-91
  • Copyright: © Sugimoto et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )
Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )


Abstract

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.
View Figures
View References

Related Articles

Journal Cover

January 2019
Volume 10 Issue 1

Print ISSN: 2049-9450
Online ISSN:2049-9469

Sign up for eToc alerts

Recommend to Library

Copy and paste a formatted citation
APA
Sugimoto, A., Nishida, T., Osugi, N., Takahashi, K., Mukai, K., Nakamatsu, D. ... Inada, M. (2019). Prediction of survival benefit when deciding between chemotherapy and best supportive therapy in elderly patients with advanced gastric cancer: A retrospective cohort study. Molecular and Clinical Oncology, 10, 83-91. https://doi.org/10.3892/mco.2018.1772
MLA
Sugimoto, A., Nishida, T., Osugi, N., Takahashi, K., Mukai, K., Nakamatsu, D., Matsubara, T., Hayashi, S., Yamamoto, M., Nakajima, S., Fukui, K., Inada, M."Prediction of survival benefit when deciding between chemotherapy and best supportive therapy in elderly patients with advanced gastric cancer: A retrospective cohort study". Molecular and Clinical Oncology 10.1 (2019): 83-91.
Chicago
Sugimoto, A., Nishida, T., Osugi, N., Takahashi, K., Mukai, K., Nakamatsu, D., Matsubara, T., Hayashi, S., Yamamoto, M., Nakajima, S., Fukui, K., Inada, M."Prediction of survival benefit when deciding between chemotherapy and best supportive therapy in elderly patients with advanced gastric cancer: A retrospective cohort study". Molecular and Clinical Oncology 10, no. 1 (2019): 83-91. https://doi.org/10.3892/mco.2018.1772