Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 11/2019

01-10-2019 | Geriatric Assessment | Peritoneal Surface Malignancy

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

Authors: Makoto Yamasaki, MD, PhD, Yoshihiro Maekawa, MD, PhD, Ken Sugimoto, MD, PhD, Tsunekazu Mizushima, MD, PhD, Hidetoshi Eguchi, MD, PhD, Toshio Ogihara, MD, PhD, Ayumi Shintani, PhD, Hiromi Rakugi, MD, PhD, Masaki Mori, MD, PhD, Yuichiro Doki, MD, PhD

Published in: Annals of Surgical Oncology | Issue 11/2019

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
Brugel L, Laurent M, Caillet P, et al. Impact of comprehensive geriatric assessment on survival, function, and nutritional status in elderly patients with head and neck cancer: protocol for a multicentre randomised controlled trial (EGeSOR). BMC Cancer. 2014;14:427.CrossRefPubMedPubMedCentral
2.
Hosking MP, Warner MA, Lobdell CM, et al. Outcomes of surgery in patients 90 years of age and older. JAMA. 1989;261:1909–15.CrossRefPubMed
3.
Turrentine FE, Wang H, Simpson VB, et al. Surgical risk factors, morbidity, and mortality in elderly patients. J Am Coll Surg. 2006;203:865–77.CrossRefPubMed
4.
Ramesh HS, Jain S, Audisio RA. Implications of aging in surgical oncology. Cancer J. 2005;11:488–94.CrossRefPubMed
5.
Epstein AM, Hall JA, Besdine R, et al. The emergence of geriatric assessment units: the “new technology of geriatrics”. Ann Intern Med. 1987;106:299–303.CrossRefPubMed
6.
Stuck AE, Siu AL, Wieland GD, et al. Comprehensive geriatric assessment: a meta-analysis of controlled trials. Lancet. 1993;342:1032–6.CrossRefPubMed
7.
Maione P, Perrone F, Gallo C, et al. Pretreatment quality of life and functional status assessment significantly predict survival of elderly patients with advanced non-small cell lung cancer receiving chemotherapy: a prognostic analysis of the multicenter Italian lung cancer in the elderly study. J Clin Oncol. 2005;23:6865–72.CrossRefPubMed
8.
Freyer G, Geay JF, Touzet S, et al. Comprehensive geriatric assessment predicts tolerance to chemotherapy and survival in elderly patients with advanced ovarian carcinoma: a GINECO study. Ann Oncol. 2005;16:1795–800.CrossRefPubMed
9.
Fukuse T, Satoda N, Hijiya K, et al. Importance of a comprehensive geriatric assessment in prediction of complications following thoracic surgery in elderly patients. Chest. 2005;127:886–91.CrossRefPubMed
10.
Dale W, Hemmerich J, Kamm A, et al. Geriatric assessment improves prediction of surgical outcomes in older adults undergoing pancreaticoduodenectomy: a prospective cohort study. Ann Surg. 2014;259:960–5.CrossRefPubMed
11.
Maekawa T, Sugimoto K, Yamasaki M, et al. Comprehensive geriatric assessment is a useful predictive tool for the duration of postoperative delirium after gastrointestinal surgery in old-old adults. Geriatr Gerontol Int. 2016;16:1036–42.CrossRefPubMed
12.
Yamamoto M, Yamasaki M, Sugimoto K, et al. Risk evaluation of postoperative delirium using comprehensive geriatric assessment in elderly patients with esophageal cancer. World J Surg. 2016;40:2705–12.CrossRefPubMed
13.
Giantin V, Valentini E, Iasevoli M, et al. Does the Multidimensional Prognostic Index (MPI), based on a Comprehensive Geriatric Assessment (CGA), predict mortality in cancer patients? Results of a prospective observational trial. J Geriatr Oncol. 2013;4:208–17.CrossRefPubMed
14.
Soubeyran P, Fonck M, Blanc-Bisson C, et al. Predictors of early death risk in older patients treated with first-line chemotherapy for cancer. J Clin Oncol. 2012;30:1829–34.CrossRefPubMed
15.
Girones R, Torregrosa D, Gomez-Codina J, et al. Prognostic impact of comorbidity in elderly lung cancer patients: use and comparison of two scores. Lung Cancer. 2011;72:108–13.CrossRefPubMed
16.
Aaldriks AA, Giltay EJ, le Cessie S, et al. Prognostic value of geriatric assessment in older patients with advanced breast cancer receiving chemotherapy. Breast. 2013;22:753–60.CrossRefPubMed
17.
Kanesvaran R, Li H, Koo KN, et al. Analysis of prognostic factors of comprehensive geriatric assessment and development of a clinical scoring system in elderly Asian patients with cancer. J Clin Oncol. 2011;29:3620–7.CrossRefPubMed
18.
Folstein MF, Folstein SE, McHugh PR. “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.CrossRefPubMed
19.
Moons KG, Harrell FE, Steyerberg EW. Should scoring rules be based on odds ratios or regression coefficients? J Clin Epidemiol. 2002;55:1054–5.CrossRefPubMed
20.
Kirkhus L, Benth JS, Rostoft S, et al. Geriatric assessment is superior to oncologist’ clinical judgement in identifying frailty. Br J Cancer. 2017;117:470–77.CrossRefPubMedPubMedCentral
21.
Tucci A, Ferrari S, Bottelli C, Borlenghi E, Drera M, Rossi G. A comprehensive geriatric assessment is more effective than clinical judgment to identify elderly diffuse large cell lymphoma patients who benefit from aggressive therapy. Cancer. 2009;115:4547–53.CrossRefPubMed
22.
Wedding U, Kodding D, Pientka L, Steinmetz HT, Schmitz S. Physicians’ judgment and comprehensive geriatric assessment (CGA) select different patients as fit for chemotherapy. Crit Rev Oncol Hematol. 2007;64:1–9.CrossRefPubMed
Metadata
Title
Development of a Geriatric Prognostic Scoring System for Predicting Survival After Surgery for Elderly Patients With Gastrointestinal Cancer
Authors
Makoto Yamasaki, MD, PhD
Yoshihiro Maekawa, MD, PhD
Ken Sugimoto, MD, PhD
Tsunekazu Mizushima, MD, PhD
Hidetoshi Eguchi, MD, PhD
Toshio Ogihara, MD, PhD
Ayumi Shintani, PhD
Hiromi Rakugi, MD, PhD
Masaki Mori, MD, PhD
Yuichiro Doki, MD, PhD
Publication date
01-10-2019
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 11/2019
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-019-07687-z

Other articles of this Issue 11/2019

Annals of Surgical Oncology 11/2019 Go to the issue

Colorectal Cancer

Quality of Life After Total Mesorectal Excision and Rectal Replacement: Comparing Side-to-End, Colon J-Pouch and Straight Colorectal Reconstruction in a Randomized, Phase III Trial (SAKK 40/04)

Urologic Oncology

4-miRNA Score Predicts the Individual Metastatic Risk of Renal Cell Carcinoma Patients

Thoracic Oncology

Risk Prediction of Postoperative Pneumonia After Subtotal Esophagectomy Based on Preoperative Serum Cholinesterase Concentrations

Sarcoma

Assessing the Role of Neoadjuvant Chemotherapy in Primary High-Risk Truncal/Extremity Soft Tissue Sarcomas: An Analysis of the Multi-institutional U.S. Sarcoma Collaborative

ASO Author Reflections

ASO Author Reflections: Routine Radiologic Staging of Distant Metastases Must Be Recommended as a Binding Guideline After Diagnosis of Local Breast Cancer Recurrence

Breast Oncology

Radiological Staging for Distant Metastases in Breast Cancer Patients with Confirmed Local and/or Locoregional Recurrence: How Useful are Current Guideline Recommendations?