What question did this study set out to answer?

To assess clinical outcomes and prognostic factors of elderly patients with advanced gastric cancer undergoing chemotherapy.

January 14, 2026

Clinical outcomes in advanced gastric cancer among elderly patients (≥80 years old) treated with chemotherapy.

Key Points

To assess clinical outcomes and prognostic factors of elderly patients with advanced gastric cancer undergoing chemotherapy.
Retrospective analysis of patients aged ≥80 years treated with first-line chemotherapy.
Patients stratified into three age groups: <70, 70–79, and ≥80 years.
Outcomes measured included overall survival, time to treatment failure, and response rates.
Median overall survival was 10.7 months (<70), 12.8 months (70-79), and 7.1 months (≥80).
Treatment discontinuation due to toxicity was higher in older age groups, reaching 24.5% in those aged ≥80.
Age ≥80 was not an independent prognostic factor, while ECOG PS and other factors were.

Abstract

351 Background: In aging societies, the proportion of elderly patients with advanced gastric cancer (AGC) is increasing; however, clinical evidence regarding chemotherapy (CTx) in patients aged ≥80 years remains limited. Methods: We retrospectively analyzed patients with AGC who received first-line CTx at Nagoya Medical Center between 2009 and 2024. Patients were stratified into three age groups: <70, 70–79, and ≥80 years. The primary outcome was overall survival (OS). Secondary outcomes included time to treatment failure (TTF) of first-line CTx, objective response rate (ORR), and the proportion of patients receiving subsequent-line therapy. Survival was estimated by the Kaplan–Meier method and compared using the log-rank test. Prognostic factors were evaluated by multivariable Cox regression. Results: A total of 322 patients were included (<70 years: 144; 70–79 years: 124; ≥80 years: 54). With increasing age, baseline Eastern Cooperative Oncology Group Performance Status (ECOG PS, p=0.007), hemoglobin (p=0.002), albumin (p=0.028), creatinine clearance (p<0.001), and Prognostic Nutritional Index (p=0.025) were worse. S-1 monotherapy was more frequently selected in patients aged ≥80 years (p=0.037). Median survival time was 10.7, 12.8, and 7.1 months in the <70, 70–79, and ≥80 groups, respectively (p=0.074). Median TTF was 4.6, 5.9, and 2.8 months (p=0.711). The ORR of first-line therapy was 49.0%, 56.5%, and 51.5% in the three groups, respectively (p=0.417). Treatment discontinuation due to toxicity occurred in 7.2%, 14.9%, and 24.5% of patients (p=0.005). The proportion of patients who did not receive subsequent-line therapy was 35.9%, 44.7%, and 64.2% (p=0.002). In multivariable analysis, age ≥80 was not an independent prognostic factor, whereas ECOG PS, neutrophil-to-lymphocyte ratio, oral intake, and treatment era (pre- vs post-nivolumab approval) were independently associated with OS. Conclusions: Although outcomes in patients ≥80 years were unfavorable, chronological age alone was not a definitive prognostic determinant. Appropriate patient selection, treatment modification, and supportive care are essential to optimize outcomes in this population.

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