Department of Surgery, The University of Minnesota, Minneapolis, MN, USA.
Ann Surg Oncol. 2011 Jan;18(1):26-33. doi: 10.1245/s10434-010-1215-9. Epub 2010 Jul 20.
Given the underrepresentation of older persons in cancer trials, the association between increasing age and receipt of recommended gastric cancer care in the United States was examined.
Using the 1998-2006 SEER database, 8637 Medicare-eligible patients, aged ≥ 65 years who underwent gastrectomy for nonmetastatic gastric adenocarcinoma were identified. Multivariate analyses was used to assess the effect of increasing age on receipt of recommended gastric cancer care (adequate lymph node evaluation [≥ 15 lymph nodes] and adjuvant radiation therapy for AJCC Ib-IVM0) and cancer-specific mortality controlling for covariates.
While 61% of gastric cancer operations were performed in patients ≥ 65 years, less than 30% received adequate lymphadenectomy or adjuvant radiation therapy. Older patients were less likely to receive adequate nodal evaluation and adjuvant radiotherapy (P < 0.0001). These findings persisted on multivariate analyses. Older age was also associated with worse cancer-specific mortality. Because an age-tumor location interaction for cancer mortality (P = 0.047) was observed, stratified analyses were performed which showed that the adverse effect of older age on cancer-specific mortality was augmented in proximal gastric cancers.
This population-based study showed significant age-based variations in gastric cancer care. These results should encourage assessment of generalizability of gastric cancer trials to this expanding population of elderly in the era of comparative effectiveness research.
由于癌症试验中老年人代表性不足，因此研究了美国老年人比例增加与接受推荐的胃癌治疗之间的关系。
使用 1998-2006 年 SEER 数据库，确定了 8637 名年龄≥65 岁的符合医疗保险条件、接受非转移性胃腺癌胃切除术的患者。采用多变量分析评估年龄增加对接受推荐的胃癌治疗（充分的淋巴结评估[≥15 个淋巴结]和 AJCC Ib-IVM0 的辅助放疗）和癌症特异性死亡率的影响，同时控制了协变量。
尽管 61%的胃癌手术是在≥65 岁的患者中进行的，但只有不到 30%的患者接受了充分的淋巴结切除术或辅助放疗。老年患者接受充分的淋巴结评估和辅助放疗的可能性较小（P<0.0001）。多变量分析也证实了这一点。老年患者还与癌症特异性死亡率增加相关。由于观察到癌症死亡率的年龄-肿瘤部位交互作用（P=0.047），因此进行了分层分析，结果显示在近端胃癌中，老年患者年龄对癌症特异性死亡率的不利影响增加。
这项基于人群的研究表明，在胃癌治疗方面存在显著的年龄差异。这些结果应鼓励在比较效果研究时代，对这一不断增长的老年人群进行胃癌试验的普遍性评估。
