title: Clinical outcomes and prognostic factors in gastric cancer patients aged ≥85 years undergoing endoscopic submucosal dissection.
abstract: OBJECTIVE
  Although the number of gastric cancer patients aged ≥85 years indicated for endoscopic submucosal dissection (ESD) has increased, little is known about the outcomes and prognostic factors. This study aimed to investigate the clinical outcomes and prognostic factors for overall survival (OS) of patients aged ≥85 years who underwent ESD for gastric cancer.
  
  
  METHODS
  We retrospectively reviewed 108 patients aged ≥85 years with 149 gastric cancers treated by ESD between 1999 and 2014 at our institution. The clinical outcomes and prognosis were evaluated. Furthermore, the relationships between patient and lesion characteristics with OS were determined using the Kaplan-Meier method and a Cox proportional hazards model.
  
  
  RESULTS
  All patients had Eastern Cooperative Oncology Group performance status (PS) of 0 to 1. En bloc, R0, and curative resections were achieved in 98.0%, 91.3%, and 72.7%, respectively, without severe adverse events requiring surgery. During a median follow-up period of 40.2 months (range, 1.8-108.7 months), 23 patients died, including 2 of gastric cancer. The 3-year (54.3% vs 95.9%) and 5-year (54.3% vs 76.3%) OS rates were significantly lower in patients with a low (<44.6) as opposed to a higher (≥44.6) prognostic nutritional index (PNI) (P < .001). The PNI was independently prognostic of OS (hazard ratio, 7.0; 95% confidence interval, 2.2-22.9; P = .001).
  
  
  CONCLUSIONS
  ESD is feasible for gastric cancer patients aged ≥85 years with good PS. However, low PNI was found to be prognostic of reduced OS, indicating the need to evaluate the PNI in determining whether to perform ESD.
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan; Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Masau
authors.initials: M
authors.lastname: Sekiguchi
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Oda
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Haruhisa
authors.initials: H
authors.lastname: Suzuki
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Abe
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Satoru
authors.initials: S
authors.lastname: Nonaka
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Shigetaka
authors.initials: S
authors.lastname: Yoshinaga
authors.affiliation: Pathology Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Taniguchi
authors.affiliation: Pathology Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Sekine
authors.affiliation: Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Saito
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000369:Aged, 80 and over; D000069916:Endoscopic Mucosal Resection; D005260:Female; D005753:Gastric Mucosa / Q000601:surgery*; D005773:Gastroscopy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome; D047368:Tumor Burden