Abstract: Objective:To investigate the prognostic factors of laparoscopic radical total gastrectomy for elderly patients with primary gastric cancer.
Methods:The retrospective casecontrol study was adopted by using propensity score matching analysis. The clinicopathological data of 338 elderly patients with primary gastric cancer who were admitted to the Union Hospital of Fujian Medical University between January 2010 and December 2012 were collected, including 246 receiving laparoscopic radical total gastrectomy (LTG) and 92 receiving open radical total gastrectomy (OTG).  The followup was performed to detect postoperative survival of patients by outpatient examination, home visit, correspondence and telephone interview till December 2015. Observation indicators included: (1) the clinicopathological data: gender, age, body mass index (BMI), Charlson scores of preoperative concomitant diseases, American Society of Anesthesiologists (ASA) grading, tumor location and diameter, number of lymph node dissected, pathologic classification of tumors and pathologic TNM (pTNM) stage. 〖HQK〗(2) All the patients were allocated into the LTG group and OTG group after a propensity score matching analysis. (3) Prognostic indicator included 3year cumulative survival rate. (4) Prognostic analysis indicators included gender, tumors location and diameter, surgical procedures, pathological classification and tumor clinical staging. (5) Independent prognostic factors were done by the stratification analysis. Measurement data with normal distribution were presented as ±s and comparison between groups was analyzed by LSDt test and matching t test. Count data were analyzed using the chisquare test. The propensity score matching analysis was done using Logistic regression model. The survival curve was drawn by KaplanMeier method and survival rate was calculated using the Logrank test. The univariate analysis and multivariate analysis were done using the COX proportional risk model.
Results:Of 338 patients, there were 87 matched pairs (87 patients in each group). There were significant differences in the age and pTNM stage before propensity score matching between the 2 groups (t=-1.692, χ²=8.437, P<0.05) and no significant difference after propensity score matching (t= -1.793, χ²=0.074, P>0.05). Among 338 patients before propensity score matching, 306 patients were followed up for a median time of 32 months (range, ²-67 months). The 3year cumulative survival rate was 58.2% and 45.3% in the LTG and OTG groups, respectively, showing a significant difference between the 2 groups (χ²=4.989, P<0.05). After propensity score matching, 159 of 174 matched patients were followed up for a median time of 36 months (range, ²-59 months). The 3year cumulative survival rate was 51.4% and 47.6% in the LTG and OTG groups, respectively, showing no significant difference between the 2 groups (χ²= 0.483, P>0.05）. The results of univariate analysis in the 174 matched patients showed that tumor diameter and clinical staging were related factors affecting the prognosis of elderly patients undergoing radical total gastrectomy of primary gastric cancer ［OR=2.697, 4.493, 95% confidence interval (CI): 1.695-4.289, 2.466-8.186, P<0.05］. The results of multivariate analysis showed that the stage Ⅲ of tumor was an independent risk factor affecting the poor prognosis of elderly patients undergoing radical total gastrectomy of primary gastric cancer (OR=3.954, 95% CI: 2.12²-7.367, P<0.05). Among 174 matched patients, 3year cumulative survival rates in the stage Ⅰ, Ⅱ and Ⅲ of tumor were 90.6%, 72.1%, 38.7% in the LTG group and 100.0%, 77.5%, 30.6% in the OTG group，respectively, with no significant difference (χ²=0.999, 0.000, 0.788, P>0.05）.
Conclusions LTG for elderly patients with primary gastric cancer is equivalent to OTG in the prognosis, and the age is not an absolute contraindication. The stage Ⅲ of tumor is an independent risk factor affecting the poor prognosis of elderly patients undergoing radical total gastrectomy of primary gastric cancer.