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