İleri yaş hastalarda gastrektomi sonrası mortalite ve nüksü öngören klinikopatolojik faktörler

Abstract

Giriş: Mide kanseri sıklıkla ileri yaşta saptanmakta olup, yaşlanma süreci artmış komorbidite yükü, azalmış fizyolojik rezerv ve olumsuz onkolojik sonuçlarla ilişkilendirilmektedir. Bu nedenle yaşlı hastalarda prognostik belirteçlerin tanımlanması, risk sınıflandırması ve bireyselleştirilmiş tedavi planlaması açısından kritik önem taşımaktadır. Amaç: Üçüncü basamak bir sağlık merkezinde gastrektomi uygulanan 65 yaş ve üzeri mide kanseri hastalarında mortalite ve nüks ile ilişkili klinikopatolojik faktörlerin belirlenmesi. Yöntem: Bu retrospektif kohort çalışmasına Van Bölge Eğitim ve Araştırma Hastanesi’nde total veya subtotal gastrektomi uygulanan, ≥65 yaşındaki 65 hasta dahil edilmiştir. Hastaların demografik özellikleri, tümör lokalizasyonu, TNM evresi, uygulanan neoadjuvan ve adjuvan tedaviler ile postoperatif sonuçları değerlendirilmiştir. Mortalite ve nüks ile ilişkili değişkenler Ki-kare ve Mann–Whitney U testleri kullanılarak analiz edilmiş; istatistiksel anlamlılık p<0.05 olarak kabul edilmiştir. Bulgular: Hastaların ortalama yaşı 73.5±5.9 olup, %73.8’i kadındı. En sık tümör lokalizasyonu kardiya bölgesi olarak saptandı (%52.3). Genel mortalite ve nüks oranları sırasıyla %80.0 ve %69.2 idi. Mortalite; ileri yaş (p<0.001), kardiya yerleşimli tümör (p=0.003) ve N3 düzeyinde lenf nodu metastazı (p=0.014) ile anlamlı ilişki gösterdi. Nüks oranı ise adjuvan tedavi uygulanmayan hastalarda (p=0.009) ve kadın cinsiyette (p=0.021) belirgin olarak daha yüksekti. Diğer klinik değişkenler ile anlamlı bir ilişki saptanmadı. Sonuç: İleri yaş, proksimal tümör yerleşimi ve ileri düzey nodal tutulum mortalitenin belirgin prognostik göstergeleri olarak öne çıkmaktadır. Adjuvan tedavi uygulanmaması ve kadın cinsiyetinin ise nüks riskini artırdığı görülmüştür. Bu bulgular, yaşlı mide kanseri hastalarında tedavi stratejilerinin dikkatle bireyselleştirilmesi ve ameliyat sonrası izlemin optimize edilmesinin önemini vurgulamaktadır.

Keywords

• Mide kanseri
• ileri yaş hastalar
• prognostik faktörler
• mortalite
• nüks
• adjuvan tedavi
• lenf nodu metastazı

Ethical Statement

Çalışma, Sağlık Bilimleri Üniversitesi Van Eğitim ve Araştırma Hastanesi Etik Kurulu onayı ile başlatılmıştır (Tarih: 2025, Karar No: GOKAEK/2025-08-30).

Clinicopathological predictors of mortality and recurrence after gastrectomy in elderly patients

Abstract

Aims: Gastric cancer remains one of the leading causes of cancer-related deaths worldwide. A significant proportion of patients are elderly, a group with unique challenges including higher comorbidity burden and reduced treatment tolerance, making the identification of prognostic determinants essential for personalized care. To evaluate clinicopathological factors associated with mortality and recurrence in gastric cancer patients aged 65 years and older undergoing gastrectomy at a tertiary referral center. Methods: This retrospective cohort study included 65 patients aged ≥65 years who underwent total or subtotal gastrectomy at a tertiary care center. Demographic, surgical, pathological, and treatment data were analyzed. Associations with mortality and recurrence were assessed using Chi-square and Mann-Whitney U tests, with statistical significance defined as p<0.05. Results: Among 65 included patients (mean age 73.5±5.9 years; 73.8% female), the cardia was the most common tumor location (52.3%). Overall mortality and recurrence rates were 80.0% and 69.2%, respectively. Mortality was significantly associated with advanced age (74.9±5.5 vs. 67.8±3.9 years, p<0.001), cardia tumor localization (57.7% vs. 30.7%, p=0.003), and N3 lymph node involvement (46.2% vs. 7.7%, p=0.014). Recurrence was significantly higher among patients not receiving adjuvant therapy (75% vs. 40%, p=0.009) and among female patients (82.2% vs. 55%, p=0.021). Conclusion: In elderly gastric cancer patients, advanced age, proximal tumor location, and extensive nodal disease predict higher mortality, while omission of adjuvant therapy and female gender are associated with increased recurrence risk. These findings highlight the need for individualized treatment strategies and optimized surveillance in this population.

Keywords

• Gastric cancer
• elderly patients
• prognostic factors
• mortality
• recurrence
• adjuvant therapy

Ethical Statement

The study was initiated with the approval of the Health Science University Van Training and Research Hospital Ethics Committee (Date: 2025, Decision No:GOKAEK/2025-08-30).

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