Clinical Outcomes in Advanced Gastric Cancer Among Patients Aged ≥80 Years Treated With Chemotherapy

Background/Aim: The proportion of older patients with advanced gastric cancer (AGC) is increasing, yet evidence regarding the clinical impact of very advanced age (≥80 years) on systemic chemotherapy efficacy and safety remains limited. This study evaluated real-world treatment patterns and outcomes across age groups and assessed the prognostic significance of advanced age in patients with AGC.

Patients and Methods: Patients with unresectable or recurrent gastric or gastroesophageal junction adenocarcinomas who received first-line systemic chemotherapy between 2009 and 2024 were included through a retrospective chart review and stratified into three age groups: <70, 70-79, and ≥80 years old. Overall survival (OS) was the primary endpoint; secondary endpoints included time-to-treatment failure (TTF), objective response rate (ORR), and disease control rate (DCR).

Results: In total, 322 patients were included. The median OS, TTF, ORR, and DCR did not differ significantly across age groups. Although age ≥80 years was associated with worse OS in univariate analysis, it was not an independent prognostic factor. Patients aged ≥80 years received fewer subsequent treatment lines and more frequently discontinued first-line therapy because of toxicity.

Conclusion: Advanced age was not an independent prognostic factor in AGC. Despite reduced treatment continuity and higher toxicity-related discontinuation in patients of advanced age, antitumor activity was similar across all age groups, supporting the use of systemic chemotherapy with careful patient selection and toxicity monitoring.