The Preoperative Frailty Versus Inflammation-Based Prognostic Score: Which is Better as an Objective Predictor for Gastric Cancer Patients 80 Years and Older?
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.
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Jun
J
Lu
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Long-Long
LL
Cao
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Chao-Hui
CH
Zheng
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Ping
P
Li
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Jian-Wei
JW
Xie
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Jia-Bin
JB
Wang
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Jian-Xian
JX
Lin
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Qi-Yue
QY
Chen
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Mi
M
Lin
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
Ru-Hong
RH
Tu
Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China. hcmlr2002@163.com.
Chang-Ming
CM
Huang
D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D000073496:Frailty / Q000150:complications*; D006801:Humans; D007249:Inflammation / Q000150:complications*; D008297:Male; D009752:Nutritional Status; D011183:Postoperative Complications / Q000209:etiology*; D057234:Preoperative Period; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000601:surgery*; D015996:Survival Rate