Surgical Resection for Stage IV Gastric Cancer: Real-World Insights with a focus on Elderly Patients (OGSG2301)
Menée à partir de données multicentriques portant sur 376 patients atteints d'un cancer gastrique de stade IV, cette étude analyse le rôle d'une résection chirurgicale après une chimiothérapie chez les patients âgés (au moins 75 ans)
Background: The introduction of molecular-targeted drugs and immune checkpoint inhibitors has improved survival in patients with stage IV gastric cancer (GC). However, the role of surgical resection for stage IV GC remains unclear, particularly in elderly patients.
Methods: This study retrospectively analyzed 376 patients with stage IV GC treated with chemotherapy across 36 institutions in 2022. We focused on differences between the elderly (≥75 years, n = 126) and non-elderly (<75 years, n = 250) groups. The surgical resection rate was the main outcome of interest; outcomes included adverse events, objective response rates (ORRs), postoperative complications, and overall survival (OS).
Results: Although the elderly group demonstrated a significantly higher adverse events (grade 3 or higher) than the non-elderly group (39.7% vs 26.8%, p = 0.013), ORRs were comparable between groups. Surgical resection rates were 12.7% and 20.4% in the elderly and non-elderly groups, respectively (p = 0.086). The elderly group exhibited more frequent postoperative complications but without significant differences (31.2% vs. 17.6%, p = 0.295). The incidence of postoperative pneumonia was higher in the elderly group (25.0% vs 2.0%). No mortality across all surgical cases was observed. Among resected cases, the 2-year OS rate was 87.5% in the elderly group and 82.2% in the non-elderly group (p = 0.741). Regarding unresected cases, the 2-year OS rates were 21.5% vs 28.4%, respectively (p = 0.112).
Conclusions: Surgical resection after systemic chemotherapy was considered an acceptable option for selected elderly patients with stage IV GC, despite the increased risk of postoperative pneumonia.
European Journal of Surgical Oncology , résumé, 2026