title: The impact of age on nodal metastases and survival in gastric cancer.
abstract: In gastric adenocarcinoma, the disparity in lymph node involvement between different age groups has not been thoroughly investigated. The objective of our study was to compare age-associated differences in adequate lymph node harvest and nodal involvement in gastric adenocarcinoma patients.
  
  
  
  We analyzed data extracted from the Surveillance, Epidemiology and End Results database on 13,165 patients diagnosed with stage I-III gastric adenocarcinoma between 2004 and 2011. All patients underwent surgical resection. Statistical comparisons between various age groups were done using the chi-square test and Cox regression.
  
  
  
  Among 13,165 gastrectomy patients, proportion of patients that had >15 lymph nodes examined decreases significantly with increasing age (P < 0.0001). When adequately staged, older patients had a significantly lower proportion of node-positive tumors (P < 0.0001). Adequate nodal staging was also associated with improved 5-y disease-specific survival across all age groups.
  
  
  
  In gastric adenocarcinoma, older patients are less likely to be adequately staged. However, when adequately staged, they are less likely to have node-positive tumors. Adherence to national guidelines, regardless of age, is associated with improved survival outcomes and may alter multimodality management of gastric cancer in the elderly.
authors.affiliation: Department of Surgery, Roger Williams Medical Center, Providence, Rhode Island; Boston University School of Medicine, Boston, Massachusetts.
authors.forename: A
authors.initials: A
authors.lastname: Ahmad
authors.affiliation: Department of Surgery, Roger Williams Medical Center, Providence, Rhode Island; Boston University School of Medicine, Boston, Massachusetts.
authors.forename: H
authors.initials: H
authors.lastname: Khan
authors.affiliation: Department of Surgery, Roger Williams Medical Center, Providence, Rhode Island; Boston University School of Medicine, Boston, Massachusetts.
authors.forename: G
authors.initials: G
authors.lastname: Cholankeril
authors.affiliation: Department of Surgery, Roger Williams Medical Center, Providence, Rhode Island; Boston University School of Medicine, Boston, Massachusetts.
authors.forename: S C
authors.initials: SC
authors.lastname: Katz
authors.affiliation: Department of Surgery, Roger Williams Medical Center, Providence, Rhode Island; Boston University School of Medicine, Boston, Massachusetts. Electronic address: psomasun@chartercare.org.
authors.forename: P
authors.initials: P
authors.lastname: Somasundar
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018426:SEER Program; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D016019:Survival Analysis
keywords: Elderly; Gastric cancer; Lymph node metastases; Survival