Scoring system for predicting the prognosis of elderly gastric cancer patients after endoscopic submucosal dissection

Abstract

Objectives: Comprehensive assessments of the long-term outcomes of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) in the elderly are unavailable. We aimed to create a scoring system to predict the long-term prognosis after ESD for EGC among patients aged ≥75 years. Methods:We conducted retrospective studies of two cohorts: a single-center cohort (2006)(2007)(2008)(2009)(2010)(2011) for developing the scoring system, and a multicenter cohort for validating the developed system (2012-2016). In the development cohort, factors related to death after ESD were identified using multivariable Cox regression analysis, and a predictive scoring system was developed. In the validation cohort, the scoring system was validated in 295 patients.Results: In the development cohort, Charlson comorbidity index (CCI) ≥3 (hazard ratio [HR] 3.017), high psoas muscle index (PMI) (HR 2.206), and age ≥80 years (HR 1.978) were significantly related to overall survival after ESD. Therefore, high CCI, low PMI, and age ≥80 years were assigned 1 point each. The patients were categorized into low (≤1 point) and high (≥2 points) score groups based on their total scores. In the validation cohort, 184 and 111 patients were assigned to the low-and high-score groups, respectively. In comparisons based on Kaplan-Meier curves, the 5-year survival rate was 91.5% in the low-score group and 57.8% in the high-score group (log-rank test; P < 0.001). Conclusion:Our scoring system including high CCI, low PMI, and age ≥80 years could stratify the long-term prognosis of elderly patients aged ≥75 years after ESD for EGC.

Clinical meaning of sarcopenia in patients undergoing endoscopic treatment

“…A retrospective study conducted by Kim et al, 31 The 5-year survival rate was significantly lower in the high-risk group than in the low-risk group (91.5% vs. 57.8%, p<0.001). 34 Our study, in which sarcopenia was diagnosed based on both SMI and IMAC, showed a significant correlation between sarcopenia and OS in the multivariate analysis (HR, 15.0; 95% CI, 5.82-38.5; p<0.001). 32 Similarly, GNRI, PNI, and CCI were significantly correlated with OS in the multivariate analysis (HR, 3.08; 95% CI, 1.40-6.76; p=0.005; HR, 2.68; 95% CI, 1.43-5.03; p=0.002; and HR, 1.84; 95% CI, 1.03-3.29; p=0.04, respectively).…”

“…Gastric ESD was most frequently reported in patients with gastric cancer, and all patients were evaluated for sarcopenia using CT. [30][31][32][33][34][35] Most studies have focused solely on assessing sarcopenia using skeletal muscle mass measurements, whereas a limited number of studies have incorporated an evaluation of muscle quality. 32 All eligible patients were Asian and were considered to be 80 years of age or older, 30,31,33 75 years of age or older, 34 65 years of age or older, 32 or all ages. 35 Table 1 shows the prevalence of sarcopenia among individuals who underwent ESD for early gastric cancer, ranging from 14.2% to 72.7%.…”

“… 21 , 39 , 40 Furthermore, investigations have been conducted on OS following gastric ESD in patients with sarcopenia ( Table 3 ). 31 - 34 A retrospective study conducted by Kim et al, 31 which included 280 patients with early gastric cancer aged over 80 years, showed that the 5-year OS rates were significantly lower in patients with sarcopenia (diagnosed based on SMI alone) than in those without sarcopenia (84.1% vs. 68.5%, p =0.046) in univariate analysis. However, OS was not associated with sarcopenia after multivariate analysis (hazard ratio [HR], 1.27; 95% CI, 0.84–1.92; p =0.266).…”

“…The 5-year survival rate was significantly lower in the high-risk group than in the low-risk group (91.5% vs. 57.8%, p <0.001). 34 …”