Differences of clinical features and outcomes between male and female elderly patients in gastric cancer

Sep 24, 2026

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Study evaluating sex-related differences in clinical features and short- and long-term outcomes among elderly gastric cancer patients. Analysis included 295 consecutive patients aged 75 years or older undergoing curative gastrectomy between 1997 and 2016. Postoperative complications were defined as Clavien–Dindo grade II or higher. Male patients showed more upper gastric cancers, higher complication rates, and worse prognoses. Multivariate models identified male sex as an independent risk factor for complications (OR 2.5) and poor prognosis (HR 1.81), supporting limited surgery for high-risk elderly males.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages8

Reading Time20 min

AccessFree to download

Introduction

Materials and methods

Patients and procedures

Follow-up and classification

Results

Discussion

Conclusion

[www. nature.com/scientificreports](www. nature.com/scientificreports) OPEN Differences of clinical features and outcomes between male and female elderly patients in gastric cancer Hiroshi Arakawa1,2, Shuhei Komatsu1,2*, Hajime Kamiya1, Keiji Nishibeppu1, Takuma Ohashi1, Hirotaka Konishi1, Atsushi Shiozaki1, Takeshi Kubota1, Hitoshi Fujiwara1 & Eigo Otsuji1 Although the average life span differs between males and females, little is known about differences in clinical features and short and long-term outcomes between elderly male and female gastric cancer patients. This study was designed to clarify these issues to identify the possibility for sex-based treatment strategies in elderly gastric cancer patients. This study included 295 consecutive elderly gastric cancer patients (75 years or older) who underwent curative gastrectomy between 1997 and 2016. We defined postoperative complications as Clavien–Dindo classification grade II or higher. Comorbidities were present in 67% of all patients. Males tended to have more comorbidities than females (P = 0.077). Male patients had significantly more upper gastric cancers (P = 0.001), a higher incidence of postoperative complications (P = 0.045), and poorer prognoses than females (P = 0.003) . Multivariate analysis revealed that being male was an independent risk factor for postoperative complications (Odds ratio 2.5, P = 0.045) and a poor prognostic factor (Hazard ratio 1.81, P = 0.008) . Patients who underwent limited surgery without postoperative complications tended to have a better prognosis than patients receiving standard surgery with postoperative complications (3-year overall survival: 78% vs. 55%, P = 0.156). Male was an independent risk factor for postoperative complications and an independent poor prognostic factor in elderly gastric cancer patients. To avoid postoperative complications, the limited surgery might be justified for high-risk elderly male patients. Remarkably, aging societies are increasing worldwide, particularly in developed countries1–3. In Japan, the incidence of elderly persons 65 years or older is 28.9%, which is considerably higher than the average incidence of 8.9% globally. Elderly gastric cancer patients are also rising because of an aging society4. Elderly patients have frailties across multiple organ systems5, which is a risk factor for postoperative complications following gastrectomy6,7. Because several studies have already identified that postoperative complications are a poor prognostic factor for patients with gastric cancer8–11, establishing appropriate treatment strategies for elderly gastric cancer patients is pivotal to improving short and long-term outcomes. The average life span differs between male and female elderly persons. Specifically, the average life expectancy of males is 6 years shorter than females (male vs. female: 82 vs. 88 years old) in Japan12. However, little is known about differences in clinical features and short and long-term outcomes between males and females following gastrectomy. In this study, we investigated these parameters to clarify these issues. We hypothesized that the prognosis may be improved by reducing complications in male, which was an independent risk factor for complications. Thus, we proposed that limited surgery could be an effective strategy, especially for patients with comorbidities. Materials and methods Patients and procedures The study was institutionally approved by the Kyoto Prefectural University of Medicine (the approved number from the review board, ERB-C-67-5), and each participant provided written informed consent. All methods were 1Division of Digestive Surgery (Gastric Surgery Division), Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan. 2These authors contributed equally: Hiroshi Arakawa and Shuhei Komatsu.*[email: skomatsu@koto.kpu-m.ac.jp](email: skomatsu@koto.kpu-m.ac.

FAQs

How many elderly gastric cancer patients were included, and what was the time range?

The study included 295 consecutive elderly gastric cancer patients aged 75 years or older. Curative gastrectomy was performed between 1997 and 2016.

How did the study define postoperative complications?

Postoperative complications were defined as Clavien–Dindo classification grade II or higher.

What did multivariate analysis show about male sex and outcomes?

Male sex was an independent risk factor for postoperative complications (OR 2.5, P=0.045) and an independent poor prognostic factor (HR 1.81, P=0.008).

Sep 24, 2026

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