title: Co-morbidities Rather than Age Impact Outcomes in Patients Receiving Preoperative Therapy for Gastroesophageal Adenocarcinoma.
abstract: BACKGROUND
  Older patients with localized gastric adenocarcinoma (LGAC) have substantial postoperative morbidity and mortality; however, postoperative outcomes of the patients who receive preoperative chemotherapy and/or chemoradiation have not been reported. We examined the impact of age at baseline on potential predictors of postoperative outcomes.
  
  
  METHODS
  Patients with LGAC who were treated with chemotherapy and/or chemoradiation followed by surgery (n = 203) formed two groups: (1) ≥65 years old (n = 70) and (2) <65 years old (n = 133). We assessed postoperative morbidity and mortality as well as overall survival (OS) and progression-free survival (PFS). Potential predictors of 90-day postoperative outcomes were identified i) by age groups and ii) other clinical covariates. Descriptive statistics and survival analyses were utilized.
  
  
  RESULTS
  90-day postoperative morbidity was similar in older and younger patients (61 % vs 58 %; P = 0.655). 90-day mortality was similar (3 % vs 0 %; P = 0.118). Major Clavien grade III/IV complications were similar (17 % vs 12 %; P = 0.392). OS and PFS were also similar for both groups (P = 0.863 and P = 0.558, respectively). Other factors, such as Charlson comorbidity index (P < 0.001) and median operative time (P = 0.002) were strongly associated with postoperative complications.
  
  
  CONCLUSIONS
  Our data show that older patients with LGAC generally have similar outcomes as do younger patients after preoperative therapy but comorbidity indices have significant impact on complications and the long-term outcomes rather than age.
authors: Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center (UTMDACC), Houston, TX, USA.
authors: Nikolaos
authors: N
authors: Charalampakis
authors: Department of Biostatistics, The University of Texas M.D. Anderson Cancer, Houston, TX, USA.
authors: Lianchun
authors: L
authors: Xiao
authors: Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center (UTMDACC), Houston, TX, USA.
authors: Quan
authors: Q
authors: Lin
authors: Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center (UTMDACC), Houston, TX, USA.
authors: Elena
authors: E
authors: Elimova
authors: Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center (UTMDACC), Houston, TX, USA.
authors: Yusuke
authors: Y
authors: Shimodaira
authors: Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center (UTMDACC), Houston, TX, USA.
authors: Kazuto
authors: K
authors: Harada
authors: Department of Pharmacy Clinical Programs, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
authors: Jane E
authors: JE
authors: Rogers
authors: Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center (UTMDACC), Houston, TX, USA.
authors: Jeannette
authors: J
authors: Mares
authors: Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center (UTMDACC), Houston, TX, USA.
authors: Fatemeh G
authors: FG
authors: Amlashi
authors: Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center U. T. M. D. Anderson Cancer Center, Houston, TX, USA.
authors: Bruce D
authors: BD
authors: Minsky
authors: Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center U. T. M. D. Anderson Cancer Center, Houston, TX, USA.
authors: Prajnan
authors: P
authors: Das
authors: Department of Thoracic and Cardiovascular Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
authors: Wayne L
authors: WL
authors: Hofstetter
authors: Department of Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
authors: Aurelio
authors: A
authors: Matamoros
authors: Department of Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
authors: Tara L
authors: TL
authors: Sagebiel
authors: Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center (UTMDACC), Houston, TX, USA.
authors: Mariela A
authors: MA
authors: Blum-Murphy
authors: Department of Gastroenterology, The University of Texas M. D. Anderson Cancer Center U. T. M. D. Anderson Cancer Center, Houston, TX, USA.
authors: Jeffrey H
authors: JH
authors: Lee
authors: Department of Gastroenterology, The University of Texas M. D. Anderson Cancer Center U. T. M. D. Anderson Cancer Center, Houston, TX, USA.
authors: Brian
authors: B
authors: Weston
authors: Department of Gastroenterology, The University of Texas M. D. Anderson Cancer Center U. T. M. D. Anderson Cancer Center, Houston, TX, USA.
authors: Manoop S
authors: MS
authors: Bhutani
authors: Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
authors: Paul F
authors: PF
authors: Mansfield
authors: Department of Pathology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
authors: Jeannelyn S
authors: JS
authors: Estrella
authors: Department of Surgical Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA.
authors: Brian D
authors: BD
authors: Badgwell
authors: Department of Gastrointestinal Medical Oncology, The University of Texas M. D. Anderson Cancer Center (UTMDACC), Houston, TX, USA. jajani@mdanderson.org.
authors: Jaffer A
authors: JA
authors: Ajani
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D000367:Age Factors; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D059248:Chemoradiotherapy / Q000401:mortality*; D003131:Combined Modality Therapy; D015897:Comorbidity; D004938:Esophageal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D020360:Neoadjuvant Therapy / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality*; D011300:Preoperative Care; D011379:Prognosis; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D015996:Survival Rate