İleri yaş hastalarda gastrektomi sonrası mortalite ve nüksü öngören klinikopatolojik faktörler

Year 2026, Volume: 8 Issue: 1, 134 - 138, 06.01.2026

Merve Yumak , Abdülkadir Deniz

https://doi.org/10.38053/acmj.1831052

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).

References

• Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-249. doi:10.33 22/caac.21660
• Machlowska J, Baj J, Sitarz M, Maciejewski R, Sitarz R. Gastric cancer: epidemiology, risk factors, classification, genomic characteristics and treatment strategies. Int J Mol Sci. 2020;21(11):4012. doi:10.3390/ijms 21114012
• Marano L, Carbone L, Poto GE, et al. Extended lymphadenectomy for gastric cancer in the neoadjuvant era: current status, clinical implications and contentious issues. Curr Oncol. 2023;30(1):875-896. doi:10.3390/curroncol30010067
• Aoki M, Kadowaki S, Takahashi N, et al. Pattern of disease progression during third-line or later chemotherapy with nivolumab associated with poor prognosis in advanced gastric cancer: a multicenter retrospective study in Japan. Gastric Cancer. 2023;26(1):132-144. doi:10.1007/s10120-0 22-01349-y
• Yan Y, Yang A, Lu L, et al. Impact of neoadjuvant therapy on minimally invasive surgical outcomes in advanced gastric cancer: an international propensity score-matched study. Ann Surg Oncol. 2021;28(3):1428-1436. doi:10.1245/s10434-020-09070-9
• Rihuete Caro C, Manzanedo I, Pereira F, Carrion-Alvarez L, Serrano Á, Pérez-Viejo E. Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) in patients with gastric cancer and peritoneal carcinomatosis. Eur J Surg Oncol. 2018;44(11):1805-1810. doi:10.1016/j.ejso.2018.06.036
• Yura M, Yoshikawa T, Otsuki S, et al. Prognostic significance of tumor location in gastric cancer patients undergoing gastrectomy. Ann Surg Oncol. 2021;28(12):7582-7591.
• Liu S, Feng F, Xu G, et al. Lymph node ratio as a predictor of recurrence and survival in gastric cancer. Cancers (Basel). 2020;12(7):1772.
• Tabernero J, Hoff PM, Shen L, et al. Pertuzumab, trastuzumab, and chemotherapy in HER2-positive gastric/gastroesophageal junction cancer: end-of-study analysis of the JACOB phase III randomized clinical trial. Gastric Cancer. 2023;26(1):123-131. doi:10.1007/s10120-02 2-01335-4
• Sugawara K, Kawaguchi Y, Seto Y, Vauthey JN. Multidisciplinary treatment strategy for locally advanced gastric cancer: a systematic review. Surg Oncol. 2021;38:101599. doi:10.1016/j.suronc.2021.101599
• El Halabi M, Horanieh R, Tamim H, et al. The impact of age on prognosis in patients with gastric cancer: experience in a tertiary care centre. J Gastrointest Oncol. 2020;11(6):1233-1241. doi:10.21037/jgo-20-139
• Ommundsen N, Nesbakken A, Wyller TB, et al. Post-discharge complications in frail older patients after surgery for colorectal cancer. Eur J Surg Oncol. 2018;44(10):1542-1547. doi:10.1016/j.ejso.2018.06.024
• Amin MB, Edge SB, Greene FL, et al. (Eds.). AJCC Cancer Staging Manual. 8th ed. Springer international publishing 2017.
• Gertsen EC, Borggreve AS, Brenkman HJF, et al. Evaluation of the implementation of fdg-pet/ct and staging laparoscopy for gastric cancer in the netherlands. Ann Surg Oncol. 2021;28(4):2384-2393. doi:10.1245/s 10434-020-09096-z
• Amin MB, Edge SB, Greene FL, et al. (Eds.). AJCC Cancer Staging Manual. 8th ed. Springer international publishing 2017.
• Ferrat E, Le Breton J, Veerabudun K, et al. Performance of four geriatric screening tools in predicting adverse outcomes in older patients with cancer. J Geriatr Oncol. 2020;11(6):997-1003.
• Hayashi T, Yoshikawa T. Optimal surgery for esophagogastric junctional cancer. Langenbecks Arch Surg. 2022;407(4):1399-1407. doi:10.1007/s004 23-021-02375-7
• Ronellenfitsch U, Schwarzbach M, Hofheinz R, et al. Preoperative chemo(radio)therapy versus primary surgery for gastroesophageal adenocarcinoma: systematic review with meta-analysis combining individual patient and aggregate data. Eur J Cancer. 2013;49(15):3149-31 58. doi:10.1016/j.ejca.2013.05.029
• In H, Solsky I, Yang J, et al. Prognostic impact of lymph node ratio after gastrectomy for gastric cancer: a multicenter cohort analysis. J Surg Oncol. 2023;127(6):1123-1132.
• Zhang CD, Yamashita H, Seto Y. Gastric cancer surgery: historical background and perspective in western countries versus Japan. Ann Transl Med. 2014;2(3):29. doi:10.21037/atm.2019.08.48
• Waddell T, Verheij M, Allum W, et al. Gastric cancer: ESMO-ESSO-ESTRO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2013;24 Suppl 6:vi57-vi63. doi:10.1093/annonc/mdt344
• Degiuli M, De Manzoni G, Di Leo A, et al. Gastric cancer: current status of lymph node dissection. World J Gastroenterol. 2016;22(10):2875-2893. doi:10.3748/wjg.v22.i10.2875
• Wang W, Li Z, Wang J, et al. Association of postoperative complications with long-term survival after gastric cancer surgery. JAMA Surg. 2021;15 6(7):e211584.
• Liu Z, Li W, Liu J, et al. Sex-based differences in clinical outcomes and tumor biology in gastric cancer patients. Sci Rep. 2021;11(1):21634.
• Demir MS, Ağdaş G. A novel non-invasive biomarker for gastric cancer: monocyte-to-hdl ratio and clinicopathological parameters in predicting survival outcomes. Cancers (Basel). 2025;17(17):2816. doi:10.3390/cance rs17172816
• Tanaka T, Suda K, Ushiku T, et al. Systemic Inflammatory Response and Its Prognostic Impact in Gastric Cancer Patients Undergoing Gastrectomy. Cancers (Basel). 2022;14(6):1453.
• Lee JK, Park YS, Lee K, et al. Prognostic significance of surgery-induced sarcopenia in the survival of gastric cancer patients: a sex-specific analysis. J Cachexia Sarcopenia Muscle. 2021;12(6):1897-1907. doi:10.10 02/jcsm.12793
• Bozzetti F. Nutritional support of the oncology patient. Crit Rev Oncol Hematol. 2013;87(2):172-200. doi:10.1016/j.critrevonc.2013.03.006
• D'Ugo D, Persiani R, Rausei S, et al. Response to neoadjuvant chemotherapy and prognosis in gastric cancer: impact of lauren classification and p53 expression. J Surg Oncol. 2004;87(4):205-211.
• Sano T, Aiko T. New Japanese classifications and treatment guidelines for gastric cancer: revision concepts and major revised points. Gastric Cancer. 2011;14(2):97-100. doi:10.1007/s10120-011-0040-6
• Jeong O, Park YK. Clinicopathological Features and Surgical Treatment of Gastric Cancer in South Korea: The Results of 2009 Nationwide Survey on Surgically Treated Gastric Cancer Patients. J Gastric Cancer. 2011;11(2):69-77. doi:10.5230/jgc.2011.11.2.69
• Smyth EC, Nilsson M, Grabsch HI, van Grieken NC, Lordick F. Gastric cancer. Lancet. 2020;396(10251):635-648. doi:10.1016/S0140-6736(20)31 288-5