Discontinuation of neoadjuvant therapy does not influence postoperative short-term outcomes in elderly patients (≥ 70 years) with resectable gastric cancer: a population-based study from the dutch upper gastrointestinal cancer audit (DUCA) data.

IF 6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Gastric Cancer Pub Date : 2024-09-01 Epub Date: 2024-06-26 DOI:10.1007/s10120-024-01522-5
Jingpu Wang, Zhouqiao Wu, Eline M de Groot, Alexandre Challine, Nadia Haj Mohammad, Stella Mook, Lucas Goense, Jelle P Ruurda, Richard van Hillegersberg
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Abstract

Background: For the elderly patients with gastric cancer, it may be more challenging to tolerate complete neoadjuvant therapy (NAT). The impact of discontinued NAT on the surgical safety and pathological outcomes of elderly patients with poor tolerance remains poorly understood.

Methods: Gastric cancer patients received gastrectomy with curative intent from the Dutch upper GI cancer audit (DUCA) database were included in this study. The independent association of age with not initiating and discontinuation of NAT was assessed with restricted cubic splines (RCS). According to the RCS results, age ≥ 70 years was defined as elderly. Short-term postoperative outcomes and pathological results were compared between elderly patients who completed and discontinued NAT.

Results: Between 2011- 2021, total of 3049 patients were included. The risk of not initiating NAT increased from 70 years. In 1954 (64%) patients receiving NAT, the risk of discontinuation increased from 55 years, reaching the peak around 74 years. In the elderly, discontinued NAT was not independently associated with worse 30-day mortality, overall complications, anastomotic leakage, re-intervention, and pathologic complete response, but was associated with a higher risk of R1/2 resection (p-value = 0.001), higher ypT stage (p-value = 0.004), ypN + (p-value = 0.008), and non-response ( p-value = 0.012).

Conclusion: A decreased utilization of NAT has been observed in Dutch gastric cancer patients from 70 years due to old age considerations, possibly because of their high risk of discontinuation. Increasing the utilization of NAT may not adversely impact the surgical safety of gastric cancer population ≥ 70 years and may contribute to better pathological results.

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停止新辅助治疗不会影响可切除胃癌老年患者(≥ 70 岁)的术后短期疗效:一项基于荷兰上消化道癌症审计(DUCA)数据的人群研究。
背景对于老年胃癌患者来说,完全耐受新辅助治疗(NAT)可能更具挑战性。对于耐受性差的老年患者来说,中断新辅助治疗对手术安全性和病理结果的影响仍不甚了解:本研究纳入了荷兰上消化道癌症审计(DUCA)数据库中接受根治性胃切除术的胃癌患者。采用限制性立方样条(RCS)评估了年龄与不开始和停止 NAT 的独立关联。根据 RCS 结果,年龄≥ 70 岁被定义为老年人。比较了完成和停止 NAT 的老年患者的术后短期疗效和病理结果:结果:2011-2021年间,共纳入3049例患者。从 70 岁开始,不使用 NAT 的风险增加。在 1954 名(64%)接受 NAT 治疗的患者中,停用 NAT 的风险从 55 岁开始增加,在 74 岁左右达到高峰。在老年人中,停用 NAT 与 30 天死亡率、总体并发症、吻合口漏、再次介入和病理完全反应的恶化无关,但与 R1/2 切除风险较高(p 值 = 0.001)、ypT 分期较高(p 值 = 0.004)、ypN +(p 值 = 0.008)和无反应(p 值 = 0.012)有关:结论:荷兰 70 岁以上胃癌患者对 NAT 的使用率有所下降,这可能是出于高龄的考虑,也可能是因为他们中断治疗的风险较高。提高 NAT 的使用率可能不会对 70 岁以上胃癌患者的手术安全性产生不利影响,而且可能有助于获得更好的病理结果。
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来源期刊
Gastric Cancer
Gastric Cancer 医学-胃肠肝病学
CiteScore
14.70
自引率
2.70%
发文量
80
审稿时长
6-12 weeks
期刊介绍: Gastric Cancer is an esteemed global forum that focuses on various aspects of gastric cancer research, treatment, and biology worldwide. The journal promotes a diverse range of content, including original articles, case reports, short communications, and technical notes. It also welcomes Letters to the Editor discussing published articles or sharing viewpoints on gastric cancer topics. Review articles are predominantly sought after by the Editor, ensuring comprehensive coverage of the field. With a dedicated and knowledgeable editorial team, the journal is committed to providing exceptional support and ensuring high levels of author satisfaction. In fact, over 90% of published authors have expressed their intent to publish again in our esteemed journal.
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