Non-metastatic gastric cancer (GC) in patients aged 80 years or older: Immediate and long-term outcomes of combined treatment.
Authors: Nikolay Semenov, Roman Izrailov, Nikita Khodos, Katerina Grechukhina, Lyudmila Zhukova
Journal: Journal of Clinical Oncology (2025)

453 Background: Comorbidities and increased risk of chemotherapy-induced toxicity in elderly patients presents significant challenges in management of GC. Here we presents a single-center experience in treatment patients aged 80 years or older with non-metastatic GS, reporting both immediate and long-term outcomes of surgical treatment (ST). Methods: This retrospective analysis includes 61 patients (pts) diagnosed with non-metastatic GC or cardio-esophageal junction (CEJ) cancer. The primary endpoint was relapse-free survival (RFS); secondary endpoints included overall survival (OS) and the incidence of surgical complications (SC). Results: Among the 61 pts (median age 82.7 years, range 80.0-89.2) 39.3% were men. ECOG PS was 0-1 in 49 pts (80.6%) and 2 – in 12 pts (19.4%). The primary tumor site was the stomach in 57 pts (93.4%) and the CEJ in 4 pts (6.6%). Tumor stage had been defined as cT 1-2 in 33.3% pts, cT 3-4 in 57.1%; cN 0 – in 36.1%, stage remained unknown in 6.3%. Radical surgery was performed in pts 78.7% (n=48), 29 pts (47.5%) of them underwent ST only without perioperative chemotherapy (CT). Neoadjuvant CT (NACT) received 23 pts (37.7%): platinum-based doublet regimen – 82.6% (n=19), while 17.4% (n=4) received capecitabine only. ST was performed in 47.8% (n=11) pts received NACT, other 12 pts didn’t undergo ST due to progression of disease (8.3%), comorbidities (33.3%), or patient preference (16.7%) in 1, 4 and 2 cases, respectively. Adjuvant CT was administered to 9 pts (14.3%). Surgical interventions included gastrectomy in 16.6% pts (n=9), proximal or distal resection – in 8.3% (n=4) and 74.1% (n=35), respectively. R0-resection was achieved in 42 pts (88.6%). SC has 20.8% (n=10) pts: classified as Clavien-Dindo grade (G) II – 4.4%, G IIIa – 8.9%, G IIIb - 8.9%; these included anastomotic leakage (6.7%), abscess formation (2.2%), cardiac events and thrombosis (4.4%), and eventration (2.2%). SC G IV or V not reported. The median duration of postoperative hospitalization was 8 days. In the overall cohort, the 3-y RFS was 53% (95%CI 28.9-53.9), 3-y OS – 67% (95%CI 27.9-75.2). Among the pts with stage IA (n=15), the 3-y RFS was 72% (95%CI 49.1-85.1), with a maximum follow-up period of 80 months and no cancer-related deaths. In patients with cT 2-4 N any 3-y RFS was 70% in the overall cohort and 74% in the surgery-only group (HR 1.09; 95%CI 0.45-2.65, p=1). Conclusions: Our findings demonstrate that over 65% of patients aged 80 years or older survive for at least 3 years following surgery for GC, with 53% living without evidence of metastases. Additionally, the rate of SC in this elderly cohort is comparable to that observed in younger populations. The role of perioperative or neoadjuvant CT in this age group remains a topic of ongoing research and discussion. It is critical to manage such population at referral oncological centers with expertise in treating elderly cancer pts.