title: Clinical significance of chemotherapy for geriatric patients with advanced or recurrent gastric cancer.
abstract: Recent clinical trials, such as JCOG9912 and SPIRITS, excluded geriatric patients aged ≥75 years. The clinical significance of intensive chemotherapy for geriatric patients with advanced or recurrent gastric cancer remains unclear. Between 2002 and 2010, 54 consecutive advanced or recurrent gastric cancer patients aged ≥75 years were enrolled in this study. We analyzed the predictors of chemotherapy administration and evaluated the survival benefit of chemotherapy for geriatric patients with advanced or recurrent gastric cancer. A total of 23 geriatric patients received no chemotherapy (GP), whereas the remaining 31 patients were administered chemotherapy (GPC). Of the 54 patients, 20 had severe concomitant illnesses, such as cardiorespiratory disease. Lymph node involvement (P=0.044) and the absence of cardiorespiratory disease (P<0.001) were found to be independently associated with chemotherapy administration. The GPC group exhibited a significantly better prognosis compared to the GP group (median survival time, 19.4 vs. 13.6 months, respectively; P=0.043). GPC patients without cardiorespiratory disease tended to have a better prognosis compared to GP patients without cardiorespiratory disease (P=0.106), whereas there were no significant differences between GP and GPC patients with cardiorespiratory disease. However, administration of chemotherapy was identified as an independent prognostic factor by the Cox proportional hazards model (hazard ratio = 2.609; 95% confidence interval: 1.173-5.761; P=0.019). Therefore, chemotherapy appears to provide a survival benefit in geriatric patients with advanced or recurrent gastric cancer, particularly those without concomitant cardiorespiratory disease.
authors.affiliation: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Kawaguchi
authors.affiliation: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Shuhei
authors.initials: S
authors.lastname: Komatsu
authors.affiliation: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ichikawa
authors.affiliation: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kubota
authors.affiliation: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Kazuma
authors.initials: K
authors.lastname: Okamoto
authors.affiliation: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Konishi
authors.affiliation: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shiozaki
authors.affiliation: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Fujiwara
authors.affiliation: Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto 6028566, Japan.
authors.forename: Eigo
authors.initials: E
authors.lastname: Otsuji
keywords: advanced gastric cancer; chemotherapy; geriatric patients