title: Outcome of gastric cancer in the elderly: a population-based evaluation of the Munich Cancer Registry.
abstract: BACKGROUND
  Gastric cancer accounts for 5 % of cancer deaths. Proportions of older stomach cancer patients are increasing. Despite the still poor prognosis, standardised treatment has achieved improvements; nonetheless it is questionable whether all age groups have benefitted. Age and outcome need to be examined in a population-based setting.
  
  
  METHODS
  Analyses included Munich Cancer Registry (MCR) data from 8601 invasive gastric cancer patients, diagnosed between 1998 and 2012. Tumour and therapy characteristics and outcome were analysed by two age groups (<70 vs. ≥70 years). Survival was analysed using the Kaplan-Meier method and relative survival was computed as an estimation for cancer-specific survival. Additional landmark analyses were conducted by calculating conditional survival of patients who survived more than 6 months.
  
  
  RESULTS
  Fifty-nine per cent of the cohort were ≥70 years old. These patients had tumours with a slightly better prognosis and were treated with less radical surgery and adjuvant therapy than younger patients. The 5-year relative survival was 40 % for the youngest (<50 years) and 23 % for the oldest patients (≥80 years). Survival differences were diminished or eliminated after landmark analyses: The 5-year relative survival in age groups 50-59, 60-69 and 70-79 years was comparable (between 48 and 49.6 %) and slightly worse in the youngest and oldest (45 %), which may be explained by more aggressive tumours and effects of cellular senescence, respectively.
  
  
  CONCLUSIONS
  The treatment and care of elderly gastric cancer patients in the MCR catchment area seems appropriate: if a patient's general condition allows oncologic resection and chemotherapy, it is conducted and the result is comparable between age groups.
authors.affiliation: Munich Cancer Registry (MCR), Munich Tumour Centre (TZM), Department of Medical Informatics, Biometry and Epidemiology (IBE), Klinikum Großhadern, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377, Munich, Germany. schlesi@ibe.med.uni-muenchen.de.
authors.forename: Anne
authors.initials: A
authors.lastname: Schlesinger-Raab
authors.affiliation: Department of Surgery, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.
authors.forename: André L
authors.initials: AL
authors.lastname: Mihaljevic
authors.affiliation: Münchner Studienzentrum (MSZ), Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Silvia
authors.initials: S
authors.lastname: Egert
authors.affiliation: Munich Cancer Registry (MCR), Munich Tumour Centre (TZM), Department of Medical Informatics, Biometry and Epidemiology (IBE), Klinikum Großhadern, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Emeny
authors.affiliation: Klinikum Großhadern, Ludwig-Maximilians-University (LMU), Munich, Germany.
authors.forename: Karl-Walter
authors.initials: KW
authors.lastname: Jauch
authors.affiliation: Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Kleeff
authors.affiliation: Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Novotny
authors.affiliation: Department of Surgery, Klinikum Neuperlach, Städtisches Klinikum München, Munich, Germany.
authors.forename: Natascha C
authors.initials: NC
authors.lastname: Nüssler
authors.affiliation: Munich Cancer Registry (MCR), Munich Tumour Centre (TZM), Department of Medical Informatics, Biometry and Epidemiology (IBE), Klinikum Großhadern, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: Miriam
authors.initials: M
authors.lastname: Rottmann
authors.affiliation: Department of Gastroenterology, Hepatology and Gastrointestinal Oncology, Klinikum Bogenhausen, Städtisches Klinikum München, Munich, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schepp
authors.affiliation: Department of Gastroenterology, Klinikum Neuperlach, Städtisches Klinikum München, Munich, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schmitt
authors.affiliation: Munich Cancer Registry (MCR), Munich Tumour Centre (TZM), Department of Medical Informatics, Biometry and Epidemiology (IBE), Klinikum Großhadern, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Schubert-Fritschle
authors.affiliation: Department of Internal Medicine, Klinik Bad Trissl, Oberaudorf, Germany.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Weber
authors.affiliation: Medical Faculty, Technische Universität München, Munich, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schuhmacher
authors.affiliation: Munich Cancer Registry (MCR), Munich Tumour Centre (TZM), Department of Medical Informatics, Biometry and Epidemiology (IBE), Klinikum Großhadern, Ludwig-Maximilians-University (LMU), Marchioninistr. 15, 81377, Munich, Germany.
authors.forename: Jutta
authors.initials: J
authors.lastname: Engel
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018279:Carcinoma, Signet Ring Cell / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011379:Prognosis; D012042:Registries; D013274:Stomach Neoplasms / Q000453:epidemiology / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D015996:Survival Rate; D055815:Young Adult
keywords: Cancer registry; Comparative effectiveness research; Elderly; Gastric cancer; Stomach cancer