Clinicopathologic characteristics and prognostic factors of gastric cancer in the elderly patients over 75 years / 中华胃肠外科杂志

<p><b>OBJECTIVE</b>To investigate the features of clinicopathology and prognosis of gastric cancer in elderly patients over 75 years old.</p><p><b>METHODS</b>A total of 193 elderly gastric cancer patients(≥75 years old) were treated in the Tumour Hospital of Harbin Medical University from January 2007 to December 2010, accounting for 5.6%, 6.5%, 6.9%, 7.9% of gastric cancer patients in each year from 2007 to 2010, respectively. Among them, 99(51.3%) patients received radical operations (radical group), 35(18.1%) patients received palliative operations (palliative group), 11(5.7%) patients received simple gastrojejunal anastomosis or gastrostomosis (anastomosis and stomy group), and 48(24.9%) patients received non-operation treatments such as chemotherapy, biology or immunology and so on (non-operation group). Clinicopathological and follow-up data of these 193 elderly patients were retrospectively analyzed. Survival time was compared among different treatment groups by Log-rank test and risk factors affecting the survival time of patients undergoing radical operation were analyzed by multivariate regression analysis.</p><p><b>RESULTS</b>The median age of these 193 elderly gastric cancer patients was 79 (75-98) years old. There were 140(72.5%) males and 53(27.5%) females. Among them, 79(40.9%) patients were complicated with anemia, 71(36.8%) with hypoproteinemia, 19(9.8%) had comorbid diabetes mellitus, 21(10.9%) had comorbid pneumonia, 54(28.0%) had history of smoking and alcohol, 14(7.3%) had genetic family history of cancer. The median overall survival time was 27.9 months. The median survival time was 38.2 months in the radical group, 17.4 months in the palliative group, 7.7 months in the anastomosis and stomy group, and 10.1 months in the non-operation group respectively, and the difference was statistically significant(P=0.000). The univariate analysis of survival time in radical group revealed that depth of invation(T stage, P=0.046), lymph node metastasis (N stage, P=0.000), tumor diameter (P=0.049), TNM staging (P=0.004), and CEA level (P=0.029) were associated with survival time. Gender, age, Borrmann type, tumor differentiation, surgical procedures, CA199 level anemia and hypoalbuminemia were not associated with the survival time(all P>0.05). Multivariate analysis revealed that lymph node metastasis was the independent prognostic factor associated with shorter survival time in the elderly patients who underwent radical resection[N1 stage: P=0.005, OR=3.481, 95% CI:1.468-8.254; N2 stage: P=0.006, OR=2.848, 95% CI:1.341-6.050; N3 stage: P=0.000, OR=4.798, 95% CI:2.207-10.432].</p><p><b>CONCLUSIONS</b>In gastric cancer patients, more and more elderly patients are being diagnosed. Radical resection can prolong their postoperative survival time, but if lymph node metastasis is present, the risk of shorter postoperative survival time elevates.</p>

The effect of omega-3 polyunsaturated fatty acids on elder patients after gastric cancer operation / 肠外与肠内营养

Objective: To investigate the clinical effect of ω-3 polyunsaturated fatty acids (ω-3 PUFA) on elder patients after gastric cancer radical operation. Methods: Forty patients were randomly divided into experimental group (EG) and control group(CG). The patients of CG were treated with hypocaloric and lower nitrogen parenteral nutrition, and those in EG received ω-3 PUFA additionally. The nutrition index, immune function, liver function, inflammatory reaction and complications were compared. Results: The rate of complications significantly decreased in the EG (20% vs 5% , χ~2 = 3. 958, P 0. 05). The level of prealbumin was significantly increased in the EG. The humoral immunity and cellular immunity were higher in the EG than those in the CG. IL-6, TNF-α and CRP levels on postoperative d5 were significantly depressed in the EG. Conclusion: Postoperative supplementation of ω-3 PUFA may have a favorable effect on the outcomes in elder gastric cancer patients.