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 3/2017

01-03-2017 | Gastrointestinal Oncology

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

Authors: Jun Lu, MD, Long-long Cao, MD, Chao-hui Zheng, MD, Ping Li, MD, PhD, Jian-wei Xie, 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

Published in: Annals of Surgical Oncology | Issue 3/2017

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
2.
Amrock LG, Neuman MD, Lin HM, et al. Can routine preoperative data predict adverse outcomes in the elderly? Development and validation of a simple risk model incorporating a chart-derived frailty score. J Am Coll Surg. 2014;219(4):684–94.CrossRefPubMedPubMedCentral
3.
Robinson TN, Eiseman B, Wallace JI, et al. Redefining geriatric preoperative assessment using frailty, disability and co-morbidity. Ann Surg. 2009;250(3):449–55.PubMed
4.
Oresanya LB, Lyons WL, Finlayson E. Preoperative assessment of the older patient: a narrative review. JAMA. 2014;311(20):2110–20.CrossRefPubMed
5.
Roxburgh CS, McMillan DC. Role of systemic inflammatory response in predicting survival in patients with primary operable cancer. Future Oncol. 2010;6(1):149–63.CrossRefPubMed
6.
Lee DY, Hong SW, Chang YG, et al. Clinical significance of preoperative inflammatory parameters in gastric cancer patients. J Gastric Cancer. 2013;13(2):111–6.CrossRefPubMedPubMedCentral
7.
8.
Mantovani A, Allavena P, Sica A, et al. Cancer-related inflammation. Nature. 2008;454(7203):436–44.CrossRefPubMed
9.
Colotta F, Allavena P, Sica A, et al. Cancer related inflammation, the seventh hallmark of cancer: links to genetic instability. Carcinogenesis. 2009;30(7):1073–81.CrossRefPubMed
10.
Chiba T, Marusawa H, Ushijima T. Inflammation-associated cancer development in digestive organs: mechanisms and roles for genetic and epigenetic modulation. Gastroenterology. 2012;143(3):550–63.CrossRefPubMed
11.
Ishizuka M, Nagata H, Takagi K, et al. Inflammation-based prognostic score is a novel predictor of postoperative outcome in patients with colorectal cancer. Ann Surg. 2007;246(6):1047–51.CrossRefPubMed
12.
13.
McMillan DC. The systemic inflammation-based Glasgow prognostic score: a decade of experience in patients with cancer. Cancer Treat Rev. 2013;39:534–40.CrossRefPubMed
14.
Edge SB, Byrd DR, Compton CC, et al. AJCC cancer staging manual, 7th edn. New York: Springer; 2009.
15.
Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma. 3rd English edition. Gastric Cancer. 2011;14(2):101–12.
16.
Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver.3). Gastric Cancer. 2011;14(2):113–23.CrossRef
17.
GS. Cho, W. Kim, HH. Kim, et al. Multicentre study of the safety of laparoscopic subtotal gastrectomy for gastric cancer in the elderly. Br J Surg. 2009;96:1437–42.CrossRefPubMed
18.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205–13.CrossRefPubMedPubMedCentral
19.
Dasgupta M, Rolfson DB, Stolee P, et al. Frailty is associated with postoperative complications in older adults with medical problems. Arch Gerontol Geriatr. 2009;48(1):78–83.CrossRefPubMed
20.
Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.CrossRefPubMed
21.
Rockwood K, Mitnitski A. Frailty in relation to the accumulation of deficits. J Gerontol A Biol Sci Med Sci. 2007;62(7):722–7.CrossRefPubMed
22.
Rolfson DB, Majumdar SR, Tsuyuki RT, et al. Validity and reliability of the Edmonton Frail Scale. Age Ageing. 2006;35(5):526–9.CrossRefPubMed
23.
Rockwood K, Andrew M, Mitnitski A. A comparison of two approaches to measuring frailty in elderly people. J Gerontol A Biol Sci Med Sci. 2007;62(7):738–43.CrossRefPubMed
24.
Theou O, Brothers TD, Mitnitski A, et al. Operationalization of frailty using eight commonly used scales and comparison of their ability to predict all-cause mortality. J Am Geriatr Soc. 2013;61(9):1537–51.CrossRefPubMed
25.
Hamel MB, Henderson WG, Khuri SF, et al. Surgical outcomes for patients aged 80 and older: morbidity and mortality from major noncardiac surgery. J Am Geriatr Soc. 2005;53(3):424–9.CrossRefPubMed
26.
Kristjansson SR, Nesbakken A, Jordhoy MS, et al. Comprehensive geriatric assessment can predict complications in elderly patients after elective surgery for colorectal cancer: a prospective observational cohort study. Crit Rev Oncol Hematol. 2010;76(3):208–17.CrossRefPubMed
27.
Role of frailty and nutritional status in predicting complications following total gastrectomy with D2 lymphadenectomy in patients with gastric cancer: a prospective study. 2016. [Epub ahead of print]. doi:10.​1007/​s00423-016-1490-4.
28.
Jiang N, Deng JY, Ding XW, et al. Prognostic nutritional index predicts postoperative complications and long-term outcomes of gastric cancer. World J Gastroenterol. 2014;20(30):10537–44.CrossRefPubMedPubMedCentral
29.
Vulliamy P, McCluney S, Mukherjee S, et al. Postoperative elevation of the neutrophil: lymphocyte ratio predicts complications following esophageal resection. World J Surg. 2016;40(6):1397–403.CrossRefPubMed
30.
Neuman HB, Weiss JM, Leverson G, et al. Predictors of short-term postoperative survival after elective colectomy in colon cancer patients ≥80 years of age. Ann Surg Oncol. 2013,20(50):1427–35.CrossRefPubMedPubMedCentral
31.
Tegels JJ, de Maat MF, Hulsewe KW, et al. Value of geriatric frailty and nutritional status assessment in predicting postoperative mortality in gastric cancer surgery. J Gastrointest Surg. 2014;18(3):439–45.CrossRefPubMed
32.
Jung MR, Park YK, Jeong O, et al. Elevated preoperative neutrophil to lymphocyte ratio predicts poor survival following resection in late stage gastric cancer. J Surg Oncol. 2011;104(5):504–10.CrossRefPubMed
33.
Aizawa M, Gotohda N, Takahashi S, et al. Predictive value of baseline neutrophil/lymphocyte ratio for T4 disease in wall-penetrating gastric cancer. World J Surg. 2011;35(12):2717–22.CrossRefPubMed
34.
Jung MR, Park YK, Jeong O, et al. Elevated preoperative neutrophil to lymphocyte ratio predicts poor survival following resection in late stage gastric cancer. J Surg Oncol. 2011;104:504–10.CrossRefPubMed
35.
Ishizuka M, Kubota K, Kita J, et al. Impact of an inflammation-based prognostic system on patients undergoing surgery for hepatocellular carcinoma: a retrospective study of 398 Japanese patients. Am J Surg. 2012;203(1):101–6.CrossRefPubMed
36.
Pinato DJ, North BV, Sharma R. A novel, externally validated inflammation-based prognostic algorithm in hepatocellular carcinoma: the prognostic nutritional index (PNI). Br J Cancer. 2012;106(8):1439–45.CrossRefPubMedPubMedCentral
37.
Smith RA, Bosonnet L, Raraty M, et al. Preoperative platelet:lymphocyte ratio is an independent significant prognostic marker in resected pancreatic ductal adenocarcinoma. Am J Surg. 2009;197(4):466–72.CrossRefPubMed
38.
Sakurai K, Ohira M, Tamura T, et al. Predictive potential of preoperative nutritional status in long-term outcome projections for patients with gastric cancer. Ann Surg Oncol. 2016;23(2):525–33.CrossRefPubMed
Metadata
Title
The Preoperative Frailty Versus Inflammation-Based Prognostic Score: Which is Better as an Objective Predictor for Gastric Cancer Patients 80 Years and Older?
Authors
Jun Lu, MD
Long-long Cao, MD
Chao-hui Zheng, MD
Ping Li, MD, PhD
Jian-wei Xie, 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
Publication date
01-03-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 3/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5656-7

Other articles of this Issue 3/2017

Annals of Surgical Oncology 3/2017 Go to the issue

Pancreatic Tumors

Long-Term Outcomes of 98 Surgically Resected Metastatic Tumors in the Pancreas

Thoracic Oncology

Clinical Significance of C-MET Overexpression and Epidermal Growth Factor Receptor Mutation in Platinum-Based Adjuvant Chemotherapy Outcome in Surgically Resected Lung Adenocarcinoma

Breast Oncology

Commentary on the Consensus Statement of the American Society of Breast Surgeons on Contralateral Prophylactic Mastectomy

Breast Oncology

Variation in the Types of Providers Participating in Breast Cancer Follow-Up Care: A SEER-Medicare Analysis

Urologic Oncology

Prognostic Impact of Renin-Angiotensin Inhibitors in Patients with Bladder Cancer Undergoing Radical Cystectomy

Breast Oncology

Outcomes of Sentinel Lymph Node-Positive Breast Cancer Patients Treated with Mastectomy Without Axillary Therapy