Factors associated with adverse events and three-year survival following endoscopic submucosal dissection for early gastric cancer in patients aged 85 years or older.

[BACKGROUND] Endoscopic submucosal dissection (ESD) is a safe and minimally invasive procedure for early gastric cancer (EGC). However, little is known about the adverse events and prognosis of gastric ESD in much older adult patients with age-related comorbidities. Therefore, we aimed to elucidate factors associated with the adverse events and prognosis of ESD for EGC in patients ≥ 85 years.

[METHODS] We enrolled 853 patients with 920 lesions ≥ 85 years old from 19 institutions who underwent ESD for EGC between January 2006 and December 2020. We adapted the Geriatric Nutritional Risk Index (GNRI) and analyzed the associations between GNRI and major adverse events post-ESD bleeding or perforation using logistic regression analysis. Subsequently, we performed the Cox proportional hazard model to elucidate whether age-related factors were associated with three-year overall survival.

[RESULTS] GNRI was significantly related with post-ESD bleeding [odds ratio (OR), 0.98; 95% confidence interval (CI), 0.96-1.00, p = 0.003]. Age (hazard ratio (HR); 95% CI 1.12 [1.02-1.22], p = 0.002), male (2.29 [1.24-3.34], p = 0.005), ECOG-Performance status (1.31 [1.16-1.75], p = 0.006), Charlson Comorbidity Index (1.17 [1.03-1.33], p = 0.002), and poor GNRI (0.92 [0.90-0.94], p < 0.001) were significantly correlated with three-year overall survival.

[CONCLUSIONS] Nutritional status was associated with post-ESD bleeding. Nutritional status and comorbidities were related with prognosis after gastric ESD. Therefore, indications of gastric ESD in patients ≥ 85 years old need to be considered with age-related comorbidities.