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Nodal involvement in gastric adenocarcinoma decreases with age; A population-based analysis
*Ali Ahmad1, *Hadi Khan1, *George Cholankeril1, *Adam Olszewski2, Ponnandai Somasundar1
1Roger Williams Medical Center, RI, Providence, RI;2Memorial Hospital of Rhode Island, Pawtucket, RI

Background: In gastric adenocarcinoma, the disparity in lymph node involvement between different age groups has not been thoroughly investigated. It may effect prognosis and define strategies for extent of surgical resection in elderly patients. The objective of our study was to compare adequate lymph node harvest and nodal involvement in gastric adenocarcinoma patients, with a focus on appropriate surgical staging in the elderly.
Methods: We analyzed data extracted from the Surveillance, Epidemiology and End Results database on 16,213 patients diagnosed with stage I-III gastric adenocarcinoma between 2004 and 2011. All patients underwent surgical resection. Comparison between age groups was made on adequate surgical staging with >15 lymph nodes examined (LNE) and nodal involvement using the chi-square test. Relative risk (RR) of adequate lymph node harvest and node-positive cancer between age groups was compared using log-binomial model.
Results: Among 16,213 gastrectomy patients, proportion of patients that had >15 LNE decreases significantly with increasing age (P <0.0001). When adequately staged, older patients had a significantly lower proportion of node-positive tumors (P < 0.0001). Additionally, older patients had a significantly higher proportion of well differentiated and moderately differentiated tumors (P <0.0001).
Conclusions: In gastric adenocarcinoma, older patients are less likely to be adequately staged. However, when adequately staged, they are less likely to have node positive tumors. The guidelines for extent of surgical resection and pathological examination should be diligently adhered to in all patients regardless of age, since adequate staging may significantly alter multimodality management of gastric cancer in the elderly.


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