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The Preoperative Frailty Versus Inflammation-Based Prognostic Score: Which is Better as an Objective Predictor for Gastric Cancer Patients 80 Years and Older?

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Due to increased life expectancy, the number of elderly patients with gastric cancer is increasing. This study was designed to determine the role of preoperative frailty (PF) as a risk factor for postoperative complications and prognosis in the oldest elderly gastric cancer patients undergoing curative resection.

Methods

A total of 165 patients older than 80 years who underwent radical gastrectomy for primary gastric cancer between 2000 and 2012 were analyzed. We collected data on the inflammation-nutritional status, morbidity, and survival of these patients. The relationship between postoperative complications and PF was analyzed by logistic regression, and a Cox proportional hazards model was performed to identify the prognostic factors.

Results

A total of 54 (32.7%) patients were considered frail. PF was associated with an increased risk for postoperative complications [odds ratio (OR) 3.396; 95% confidence interval (CI) 1.046–11.025; P = 0.042]. With a median follow-up of 37.0 (range 1.0–77.8) months, the 3 year overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS) rates in the entire cohort were 46.1, 34.4, and 49.2%, respectively. A multivariate analysis of the inflammation-based prognostic factors showed that only PF was independently associated with OS (OR 1.613; 95% CI 1.052–2.473; P = 0.028), RFS (OR 1.859; 95% CI 1.279–2.703; P = 0.001), and CSS (OR 1.859; 95% CI 1.279–2.703; P = 0.001).

Conclusions

Frailty based on an easily calculable preoperative measure is a useful marker to identify patients at increased risk for postoperative complications and is more predictive of survival than an inflammation-based prognostic score after gastrectomy. Thus, PF status should be included in the routine assessment of the oldest elderly patients with gastric cancer.

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Acknowledgement

All of the authors are grateful for the statistics related consultation provided by the Public Health School of Fujian Medical University.

Disclosure

All of the authors declare that they have no potential commercial conflicts of interest relevant to this article.

Funding

This work was supported by the National Key Clinical Specialty Discipline Construction Program of China (No. [2012] 649) and Key Projects of Science and Technology Plan of Fujian Province (No. 2014Y0025).

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Authors and Affiliations

  1. Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China

    Jun Lu MD, Long-long Cao MD, Chao-hui Zheng MD, ** Li MD, PhD, Jian-wei **e MD, Jia-bin Wang MD, Jian-xian Lin MD, Qi-yue Chen MD, Mi Lin MD, Ru-hong Tu MD & Chang-ming Huang MD, PhD

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  1. Jun Lu MD
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Correspondence to Chang-ming Huang MD, PhD.

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Lu, J., Cao, Ll., Zheng, Ch. et al. The Preoperative Frailty Versus Inflammation-Based Prognostic Score: Which is Better as an Objective Predictor for Gastric Cancer Patients 80 Years and Older?. Ann Surg Oncol 24, 754–762 (2017). https://doi.org/10.1245/s10434-016-5656-7

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