Makoto Hikage

Reply to comment on “Are body mass index and performance status enough to assess the nutritional and functional status of elderly patients undergoing gastric cancer surgery?”

We thank Lidoriki et al. for their interest in our paper [1], which investigated the feasibility of gastrectomy for very elderly patients (≥ 85 years of age). The results of our study suggest that chronological age alone is not a valid reason for avoiding gastrectomy, and a comprehensive assessment is necessary to determine the optimum treatment strategy for elderly patients with gastric cancer. The results of a multivariate analysis, which did not identify chronological age as an independent prognostic factor, also support our view that gastrectomy should be considered regardless of chronological age as long as the physical capacity is maintained [1]. We partially agree with Lidoriki et al. that sarcopenia and frailty have recently emerged as significant prognostic factors for the postoperative outcomes of geriatric patients. Indeed, previous studies have clearly demonstrated a significant relationship between sarcopenia and postoperative complications [2]; however, whether or not this relationship holds true in terms of the long-term post-surgical survival remains controversial. A recent meta-analysis included only two studies with a long-term survival assessment, and the results were inconsistent [2]. We also investigated the impact of sarcopenia on the long-term outcomes in elderly gastric cancer patients and reported adverse effects on the survival outcomes [3], which is consistent with the findings of a study conducted by Zhuang et al. [4]. In addition, Kudou et al. reported a strong relationship between the postoperative development of sarcopenia and poor long-term survival outcome [5]. Conversely, Tegels et al. [6] reported no association of sarcopenia with the postoperative morbidity and survival outcomes. Such inconsistency among studies most likely reflects the different definitions of sarcopenia and elderly in each study. Consequently, sarcopenia cannot be considered a robust prognosticator for elderly patients undergoing gastrectomy, although this issue remains to be fully investigated. Therefore, it is not necessary to include sarcopenia as a covariate for multivariable analyses of the long-term survival outcomes. In conclusion, while sarcopenia should definitely be integrated into the preoperative assessment tool for elderly patients, robust evidence needs to be gathered concerning both the early postoperative outcomes and the long-term survival.

Impact of extra-nodal metastasis on survival in gastric cancer patients with lymph node involvement.

57Background: Extra-nodal metastasis (ENM) is defined as a tumor nodule without lymph node structure, and distinguished from lymph node metastasis by histological findings. Despite the possible difference in metastatic mechanism, both are counted as metastasized lymph nodes according to the 3rd English edition of Japanese Classification of Gastric Carcinoma, and thus the prognostic value of ENM remains unclear. The aim of this study was to clarify the clinicopathogical characteristics and prognostic impact of ENM in gastric cancer patients with lymph node involvement. Methods: This study included 388 patients who underwent curative gastrectomy for primary gastric cancer between January 2009 and August 2013. A total of 2093 pathologically positive tumor nodules, including both metastatic lymph nodes and ENM, were examined. Clinicopathological characteristics and survival outcomes were compared between an ENM positive (ENMP) group (95 patients) and an ENM negative (ENMN) group (293 patients). In addition, m...

Molecular classification of Japanese gastric adenocarcinoma.

e15565Background: Gastric cancer is well known as having heterogeneous features. Recently, TGCA project had successfully established a molecular classification of gastric adenocarcinoma. In additio...

Impact of sarcopenia on short- and long-term outcomes in patients with gastric cancer.

19 Background: Depletion of skeletal muscle in aged people (sarcopenia) regarded as a poor prognostic factor in various cancers. The aim of this study was to assess the impact of preoperative sarcopenia on postoperative short- and long-term outcomes in patients with gastric cancer underwent curative resection. Methods: A total of 881 patients who underwent R0 resection for gastric cancer aged 65 or older between June 2003 and March 2011 were included in this study. Muscle mass was assessed by measuring percentage of arm muscle area (%AMA). Preoperative sarcopenia was defined as aged 65 or older, %AMA <80%, and decline in grip strength ( <25kg in men, <20kg in women), according to algorithm suggested by European Working Group on Sarcopenia in Older People (EWGSOP) with slight modification. Relationship between sarcopenia and short- and long-term outcomes were evaluated using uni- and multi-variate analysis. Results: Of 881 patients, sarcopenia was diagnosed in 62 patients (7.0%). Incidence of sarcopenia wa...

Role of palliative resection in patients with incurable advanced gastric cancer unfit for chemotherapy.

114 Background: Recently, REGATTA trial showed that debulking surgeries followed by chemotherapy did not improve survival outcomes compared to chemotherapy alone for incurable advanced gastric cancer (AGC). Therefore, the standard treatment for incurable AGC without emergent symptom is not gastrectomy plus chemotherapy but chemotherapy alone. However, in patients who are unfit for chemotherapy due to poor performance status (PS), age, or comorbid chronic diseases, the role of palliative gastrectomy remains controversial. The aim of this study is to determine the role of palliative resection in patients with incurable AGC unfit for chemotherapy. Methods: Two hundred and twelve gastric cancer patients having any cause of incurable factors and underwent palliative gastrectomy or bypass operation between November 2002 and December 2014 were enrolled. Of these 212 patients, 64 patients who did not receive any chemotherapy were divided into two groups; Gastrectomy group with 45 patients who underwent palliative...