Clinical efficacy of neoadjuvant chemotherapy combined with radical gastrectomy in elderly patients with advanced gastric cancer

Abstract

BACKGROUND

Neoadjuvant chemotherapy combined with radical gastrectomy is a safe and effective treatment for elderly patients with advanced gastric cancer. Despite the increased risk of pulmonary complications, such as pleural effusion and pulmonary infection, postoperative recovery time and survival outcomes are similar to younger patients.

AIM

To investigate the safety and efficacy of neoadjuvant chemotherapy combined with radical gastrectomy in elderly patients with advanced gastric cancer by comparing treatment-related complications, surgical outcomes, and long-term survival between elderly patients (≥ 65 years) and younger patients (< 65 years).

METHODS

The clinical data of 148 patients with advanced gastric cancer in elderly patients who received neoadjuvant chemotherapy in our hospital from January 2015 to October 2023 were retrospectively analyzed, and these patients were divided into young and middle-aged groups (111 patients) and elderly groups (37 patients), and their clinicopathology and prognosis were compared.

RESULTS

Neoadjuvant chemotherapy induced anemia (χ² = 0.235, P = 0.628), leukopenia (χ² = 0.613, P = 0.434), neutropenia (χ² = 0.011, P = 0.918) and thrombocytopenia (χ² = 0.253, P = 0.628) in both groups. Hematological complications, nausea (χ² = 0.092, P = 0.762), vomiting (χ² = 0.166, P = 0.683), diarrhea (χ² = 0.015, P = 0.902) and mucositis (χ² = 0.199), and there was no significant difference in the incidence of nonhematological complications (P = 0.766). Between the old group and the young and middle-aged groups, no significant differences were observed in operative time (t = 0.270, P = 0.604), intraoperative blood loss (t = 1.140, P = 0.250), or R0 removal rate (χ² = 0.105, P = 0.750). Although the incidence of postoperative complications was higher in the old group (37.8%) compared to the young and middle-aged groups (25.2%), this difference did not reach statistical significance (χ² = 2.172, P = 0.141). However, the elderly group demonstrated significantly higher incidences of pleural effusion (χ² = 7.007, P = 0.008) and pulmonary infection (χ² = 10.204, P = 0.001) than the young and middle-aged groups. When examining survival outcomes, neither the 3-year progression-free survival (t = 0.494, P = 0.482) nor the 3-year overall survival (t = 0.013, P = 0.908) showed significant differences between the elderly group and the young and middle-aged groups.

CONCLUSION

Neoadjuvant chemotherapy combined with radical gastrectomy is safe and effective in elderly patients with advanced gastric cancer, but there are more pulmonary complications (specifically pleural effusion and pulmonary infection) during the perioperative period.

Keywords: Gastric neoplasms; Tumor adjuvant therapy; Elderly people; Postoperative complications; Survival prognosis

Core Tip: Neoadjuvant chemotherapy combined with radical gastrectomy is a safe and effective treatment for elderly patients with advanced gastric cancer. Despite the increased risk of pulmonary complications, such as pleural effusion and pulmonary infection, postoperative recovery time and survival outcomes are similar to younger patients. Hematological and non-hematological complications related to chemotherapy are generally manageable. While age-related factors may affect chemotherapy tolerance, the combination therapy significantly improves surgical resectability and prognosis. Close monitoring of renal function and attention to pulmonary and cardiovascular issues are crucial for optimizing treatment outcomes in elderly gastric cancer patients.