No regional survival disparities following curative gastrectomy in patients aged over 80 years with gastric cancer. a multicenter retrospective study.

[PURPOSE] To evaluate whether regional treatment settings are associated with differences in the clinical outcomes among older gastric cancer patients undergoing curative gastrectomy.

[METHODS] This multicenter retrospective study included 327 patients aged ≥ 80 years who underwent curative gastrectomy for gastric cancer. The patients were classified into urban (n = 118) and rural (n = 209) groups. The baseline characteristics, surgical outcomes, and long-term outcomes were compared.

[RESULTS] Patients in rural areas had poorer performance statuses, more comorbidities, worse nutritional and inflammatory profiles, and longer distances to the hospital. However, no differences were observed between the urban and rural groups in terms of the surgical approach, postoperative complication rates, or the administration of adjuvant chemotherapy. The 5-year overall survival rates in the rural and urban groups were 66.6% and 59.8%, respectively (p = 0.197). A multivariate Cox regression analysis identified Eastern Cooperative Oncology Group performance status ≥ 2 (hazard ratio: 2.02), carcinoembryonic antigen ≥ 5 ng/mL (hazard ratio: 1.92), pathological stage III (hazard ratio: 3.72), and Clavien-Dindo grade ≥ III complications (hazard ratio: 2.51) as independent predictors of overall survival.

[CONCLUSION] The comparable surgical and long-term survival outcomes between patients treated in rural and urban areas suggest that equitable surgical care may be achievable across different geographic settings.