Title

Outcomes of Various Treatment Sequencing Strategies in Octogenarians with Gastric Adenocarcinoma: A National Cancer Database Analysis

Document Type

Conference Proceeding

Publication Date

9-2019

Publication Title

J AM Coll Surg

Abstract

Introduction: Perioperative therapy for gastric adenocarcinoma (GA) has demonstrated survival benefit. Multimodality therapy in the elderly can be challenging due to comorbidities/frailty. We aimed to describe outcomes of various treatment sequencing strategies in octogenarians with non-metastatic GA. Methods: The National Cancer Database was queried for patients with GA from 2010 to 2015. Patients with stage I to III disease aged 80 to 89 years at diagnosis were included, then stratified into 3 groups: resection only (R), systemic therapy only (ST), and resection with systemic therapy (neoadjuvant and/or adjuvant therapy; R+ST). Overall survival was estimated from time of diagnosis using Kaplan-Meier curves and compared using log-rank tests (LRT). Multivariable Cox proportional hazard models were used to compare overall survival among treatment groups, adjusted for demographic and clinicopathologic data (Figure). Results: A total of 2,652 octogenarians with stage I to III GA were identified (R, n = 665; ST, n = 1,680; R+ST, n = 307). Systemic therapy only was the predominant treatment strategy in stage II to III disease. Stage I median survival, R: 50 months, ST: 17.6 months, R+ST: 35.9 months (LRT: R vs ST; p < 0.001, R+ST vs ST; p < 0.001, R vs R+ST; p = 0.175). Systemic therapy only was an independent risk factor for mortality in stage I on multivariable Cox proportional hazard model analysis (reference: R). Stage II median survival, R: 18.5 months, ST: 16.3 months, R+ST: 29.2 months (LRT: R vs ST; p = 0.242, R+ST vs ST; p < 0.001, R vs R+ST; p = 0.008). Stage III median survival, R: 12.0 months, ST: 13.6 months, R+ST: 19.7 months (LRT: R vs ST; p = 0.475, R+ST vs ST; p < 0.001, R vs R+ST; p = 0.082). Systemic therapy only was not an independent risk factor for mortality in stage II to III on multivariable Cox proportional hazard model analysis (reference: R). Conclusions: Although ST represented a risk factor for mortality in octogenarians with stage I, ST-only appears non-inferior to R-only in stage II to III GA. Outlining outcomes of treatment approaches for octogenarians with GA can aid in patient counseling and clinical decision-making. [Figure presented]

Volume

229

Issue

4

First Page

S270

Last Page

S271

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