Relationship between frailty and mortality after gastrectomy in older patients with gastric cancer

Abstract

Objectives: Frail older adults with gastric cancer are at an increased risk of poor postoperative outcomes. We assessed whether geriatric frailty assessed using the Study of Osteoporotic Fractures (SOF) index could predict post-gastrectomy mortality. Materials and methods: We retrospectively assessed older adults (age ≥ 65 years) who underwent gastrectomy for gastric cancer between April 2012 and September 2015. Frailty status was assessed using the SOF index (range, 0-3) and categorized as robust (0), pre-frail (1), and frail (2-3). The Kaplan-Meier method and log-rank tests were used to compare survival between frailty groups. Univariate and multivariate analyses were used to identify mortality-associated risk factors. Results: Among 231 patients (the median age 72.04 years and 140 (60.6%) men), 138 (59.7%) were robust, 58 (25.1%) were pre-frail, and 35 (15.2%) were frail. The mortality rate was 14.5% among robust patients, 20.7% among pre-frail patients, and 20.0% among frail patients (log-rank test, P = 0.032). Frail patients had more than a 3-fold increased risk of mortality compared with robust patients (adjusted HR = 3.331; 95% CI, 1.161-9.559). Multivariate analysis revealed that the SOF index and TNM stage were associated with increased mortality. Conclusions: SOF index predicted post-gastrectomy mortality among older patients independently of age, sex, TNM stage, type of approach, gastrectomy type, and extent of lymph node dissection. SOF index may be used with ease to assess frailty status among older patients with gastric cancer in busy clinics and subgroups that may benefit from targeted frailty interventions before cancer treatments.

Impact of frailty on survival and readmission in patients with gastric cancer undergoing gastrectomy: A meta-analysis

“…After evaluating the titles and abstracts, 23 articles were retrieved for full-text evaluation. Two articles (12,23) were obtained from the same population and reported the different clinical outcomes. Finally, eight studies reported on nine articles (12,13,(15)(16)(17)(18)(23)(24)(25) were included in the meta-analysis (Figure 1).…”

“…Two articles ( 12 , 23 ) were obtained from the same population and reported the different clinical outcomes. Finally, eight studies reported on nine articles ( 12 , 13 , 15 – 18 , 23 – 25 ) were included in the meta-analysis ( Figure 1 ).…”

“…The major characteristic of the included studies is summarised in Table 1 . These studies were published from 2014 to 2022 and conducted in South Korea ( 12 , 23 ), Republic of Korea ( 17 ), Japan ( 15 , 16 ), The Netherlands ( 18 ), USA ( 25 ), and China ( 13 ). Two articles ( 13 , 17 ) adopted a prospective design, while the others adopted a retrospective design.…”

Treatment of Older Adult Patients with Glioblastoma: Moving towards the Inclusion of a Comprehensive Geriatric Assessment for Guiding Management

“…Currently, the majority of surgical treatment decisions and frailty assessments of older patients with GBM are based on age, functional status, and general provider impression as opposed to more objective measures [ 25 , 26 ]. Frailty indexes have been useful for predicting postoperative complications in other cancer surgeries [ 27 , 28 ]. Using the Canadian Study on Health and Aging Modified Frailty Index (mFI) Cloney et al [ 29 ] conducted a retrospective analysis of 319 patients aged 65 or older with pathologically confirmed glioblastoma and assessed surgical outcomes.…”

Associação entre cistatina C, fragilidade e desfechos clínicos em idosos com câncer

“…7 Em idosos com câncer no cenário cirúrgico, ser frágil aumentou em três vezes o risco de mortalidade em pacientes com câncer gástrico em um estudo retrospectivo: taxa de mortalidade foi de 14,5% entre os pacientes robustos, 20,7% entre os pacientes préfrágeis e 20,0% entre os pacientes frágeis (teste de log-rank, P = 0,032). 14 Maior taxa de complicações pós-operatórias, classificadas pela escala Clavien-Dindo (maior que grau 3), foram observadas em pacientes idosos frágeis com câncer colorretal (62% versus 28%, p < 0,001). 15 Em pacientes submetidos à cirurgia de cabeça e pescoço avaliados prospectivamente, independentemente da idade, a fragilidade avaliada pelo Índice de…”