title: The recommended treatment strategy for locally advanced gastric cancer in elderly patients aged 75 years and older: a Surveillance, Epidemiology, and End Results database analysis.
abstract: BACKGROUND
  As patients aged 75 years and older are often underrepresented in randomized clinical trials, the external validity of clinical trials-based recommendations in older gastric patients was still controversial. The aim of this study is to explore the recommended treatment strategy for locally advanced gastric cancer in elderly patients.
  
  
  METHODS
  We designed our study to specifically evaluate the cancer-specific survival (CSS) of four subgroups of patients according to four different treatment modalities: adjuvant radiation (RT), surgery only, RT only and no surgery/no RT by analyzing the Surveillance, Epidemiology, and End Results (SEER)-registered database. Kaplan-Meier methods were adopted and multivariable Cox regression models were built for the analysis of survival outcomes and risk factors.
  
  
  RESULTS
  The 5-year CSS was 43.8 % in adjuvant RT, 28.5 % in surgery only, 14.9 % in RT only and 1.4 % in no surgery/no RT, which had significant difference in univariate log-rank test (P < 0.001) and multivariate Cox regression (P < 0.001). Moreover, we observed significant survival benefits in adjuvant RT group in all age categories, including age 75-79 years, age 80-84 years and age ≥85 years (all P < 0.001).
  
  
  CONCLUSIONS
  Surgery and adjuvant RT may be the recommended treatment strategy in elderly patients with locally advanced gastric cancer, especially for patients medically fit for the combined modality therapy.
authors.affiliation: Department of Radiation Oncology, Lihuili Hospital, Ningbo Medical Center, No. 57, Xing'Ning Road, Ningbo, 315041, China.
authors.forename: Kai-Tai
authors.initials: KT
authors.lastname: Liu
authors.affiliation: Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.|Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Jue-Feng
authors.initials: JF
authors.lastname: Wan
authors.affiliation: Department of Radiation Oncology, Huzhou Central Hospital, Huzhou, Zhejiang Province, China.
authors.forename: Gen-Hua
authors.initials: GH
authors.lastname: Yu
authors.affiliation: Department of Radiation Oncology, Lihuili Hospital, Ningbo Medical Center, No. 57, Xing'Ning Road, Ningbo, 315041, China.
authors.forename: Yan-Ping
authors.initials: YP
authors.lastname: Bei
authors.affiliation: Department of Radiation Oncology, Lihuili Hospital, Ningbo Medical Center, No. 57, Xing'Ning Road, Ningbo, 315041, China.
authors.forename: Xue
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Radiation Oncology, Lihuili Hospital, Ningbo Medical Center, No. 57, Xing'Ning Road, Ningbo, 315041, China. lmz2005@yeah.net.
authors.forename: Miao-Zhen
authors.initials: MZ
authors.lastname: Lu
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D016016:Proportional Hazards Models; D018426:SEER Program; D013274:Stomach Neoplasms / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome
keywords: Elderly; Gastric cancer; SEER; Treatment