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Development of a Geriatric Prognostic Scoring System for Predicting Survival After Surgery for Elderly Patients With Gastrointestinal Cancer

  • Peritoneal Surface Malignancy
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Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The number of elderly patients with gastrointestinal cancer is rising as the population ages. This study aimed to assess the impact of a preoperative geriatric assessment on postoperative survival and to develop a geriatric prognostic scoring system (GPSS) for elderly patients.

Methods

Patients (n = 544) age 75 years or older who had undergone radical surgery for gastrointestinal cancer were recruited for this observational study. Geriatric assessments (GAs) using the Barthel Index, the Mini-Mental State Examination, Instrumental Activities of Daily Living, the Vitality Index, and the Geriatric Depression Score were administered before surgery. Multivariable analysis was performed using a Cox proportional hazard regression model to identify significant prognostic factors. The GPSS was developed using regression coefficients of the multivariable regression to predict overall survival (OS). Thereafter, 165 consecutive patients were prospectively validated to test the authors’ model.

Results

The independent predictors of OS appeared to be GA as well as age, type of cancer, clinical stage, performance status, and body mass index. The patients were classified into high- and low-risk groups according to the GPSS. The overall 3-year survival was 79% in the low-risk group and 26% in the high-risk group (hazard ratio [HR], 5.69; 95% confidence interval [CI] 4.35–7.42; p < 0.0001). Furthermore, when GPSS was applied to independent cohorts, the patients in the high-risk group showed significantly poorer prognoses than those in the low-risk group (HR, 4.49; 95% CI 2.65–7.60; p < 0.0001).

Conclusions

Geriatric assessments were closely associated with postoperative OS. The GPSS is useful in predicting postoperative prognosis and may help determine treatment strategies for elderly patients with gastrointestinal cancer.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2-E2, Yamadaoka, Suita, Osaka, 565-0871, Japan

    Makoto Yamasaki MD, PhD, Tsunekazu Mizushima MD, PhD, Hidetoshi Eguchi MD, PhD, Masaki Mori MD, PhD & Yuichiro Doki MD, PhD

  2. Geriatric Medicine, Osaka University Graduate School of Medicine, Osaka, Japan

    Yoshihiro Maekawa MD, PhD, Ken Sugimoto MD, PhD & Hiromi Rakugi MD, PhD

  3. Morinomiya University of Medical Sciences, Osaka, Japan

    Toshio Ogihara MD, PhD

  4. Clinical Epidemiology and Biostatistics, Osaka University Graduate School of Medicine, Osaka, Japan

    Ayumi Shintani PhD

Authors
  1. Makoto Yamasaki MD, PhD
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  2. Yoshihiro Maekawa MD, PhD
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  3. Ken Sugimoto MD, PhD
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  4. Tsunekazu Mizushima MD, PhD
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  5. Hidetoshi Eguchi MD, PhD
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  6. Toshio Ogihara MD, PhD
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  7. Ayumi Shintani PhD
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  8. Hiromi Rakugi MD, PhD
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  9. Masaki Mori MD, PhD
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  10. Yuichiro Doki MD, PhD
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Corresponding author

Correspondence to Makoto Yamasaki MD, PhD.

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10434_2019_7687_MOESM1_ESM.bmp

Supplementary Figure 1. Receiver operating characteristic (ROC) curves for the geriatric prognostic scoring system (GPS) scores for 1-year overall survival. (BMP 3924 kb)

Supplementary material 2 (DOCX 22 kb)

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Yamasaki, M., Maekawa, Y., Sugimoto, K. et al. Development of a Geriatric Prognostic Scoring System for Predicting Survival After Surgery for Elderly Patients With Gastrointestinal Cancer. Ann Surg Oncol 26, 3644–3651 (2019). https://doi.org/10.1245/s10434-019-07687-z

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  • DOI: https://doi.org/10.1245/s10434-019-07687-z

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