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Long-term outcomes after endoscopic resection for late-elderly patients with early gastric cancer

Published:December 31, 2021DOI:https://doi.org/10.1016/j.gie.2021.12.028

      Background and Aims

      With the population aging, the incidence of early gastric cancer (EGC) is increasing. We aimed to clarify the indications for endoscopic resection (ER) in late-elderly patients with EGC in terms of life expectancy.

      Methods

      Patients aged ≥75 years who underwent ER for EGC at our institution from January 2007 to December 2012 were enrolled. Clinical data, including Eastern Cooperative Oncology Group performance status (ECOG-PS), Charlson comorbidity index, and Prognostic Nutritional Index (PNI), were collected at the time of ER. Overall survival (OS) was the main outcome measure.

      Results

      Four hundred consecutive patients were enrolled. Mean patient age was 79.3 years (range, 75-93). The 5-year follow-up rate was 89.0% (median follow-up period, 5.6 years). Five-year OS was 80.8% (95% confidence interval [CI], 76.4-84.4), and 5-year net survival standardized for age, sex, and calendar year was 1.09 (95% CI, 1.03-1.15). With a multivariate analysis, ECOG-PS 2 to 4 (hazard ratio, 8.84; 95% CI, 3.07-25.4), PNI <49.1 (hazard ratio, 2.49; 95% CI, 1.53-4.06), and eCura C-2 (hazard ratio, 1.79; 95% CI, 1.11-2.88) were independent prognostic factors. When none of these factors was met, the 5-year OS rate was 90.4% (95% CI, 84.0-94.3).

      Conclusions

      ER for EGC in late-elderly patients may improve life expectancy. ER is recommended in patients with a good ECOG-PS and PNI and in whom ER is expected to be non-eCura C-2.

      Abbreviations:

      ASA-PS (American Society of Anesthesiologists performance status), CCI (Charlson comorbidity index), CI (confidence interval), ECOG-PS (Eastern Cooperative Oncology Group performance status), eCura (scoring system to stratify curability after endoscopic submucosal dissection for early gastric cancer), EGC (early gastric cancer), ER (endoscopic resection), ESD (endoscopic submucosal dissection), GC (gastric cancer), OS (overall survival), PNI (Prognostic Nutritional Index)
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