Nutr Res Pract.  2022 Oct;16(5):604-615. 10.4162/nrp.2022.16.5.604.

Risk factors for cancer-specific survival in elderly gastric cancer patients after curative gastrectomy

Affiliations
  • 1Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
  • 2Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
  • 3Graduate School, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China

Abstract

BACKGROUND/OBJECTIVES
This study aimed to investigate cancer-specific survival (CSS) and associated risk factors in elderly gastric cancer (EGC) patients.
SUBJECTS/METHODS
EGC patients (≥ 70 yrs) who underwent curative gastrectomy between January 2013 and December 2017 at our hospital were included. Clinicopathologic characteristics and survival data were collected. Receiver operating characteristic (ROC) analysis was used to extract the best cutoff point for body mass index (BMI). A Cox proportional hazards model was used to determine the risk factors for CSS.
RESULTS
In total, 290 EGC patients were included, with a median age of 74.7 yrs. The median follow-up time was 31 (1–77) mon. The postoperative 1-yr, 3-yr and 5-yr CSS rates were 93.7%, 75.9% and 65.1%, respectively. Univariate analysis revealed risk factors for CSS, including age (hazard ratio [HR] = 1.08; 95% confidence interval [CI], 1.01–1.15), intensive care unit (ICU) admission (HR = 1.73; 95% CI, 1.08–2.79), nutritional risk screening (NRS 2002) score ≥ 5 (HR = 2.33; 95% CI, 1.49–3.75), and preoperative prognostic nutrition index score < 45 (HR = 2.06; 95% CI, 1.27–3.33). The ROC curve showed that the best BMI cutoff value was 20.6 kg/m 2 . Multivariate analysis indicated that a BMI ≤ 20.6 kg/m 2 (HR = 2.30; 95% CI, 1.36–3.87), ICU admission (HR = 1.97; 95% CI, 1.17–3.30) and TNM stage (stage II: HR = 5.56; 95% CI, 1.59–19.43; stage III: HR = 16.20; 95% CI, 4.99–52.59) were significantly associated with CSS.
CONCLUSIONS
Low BMI (≤ 20.6 kg/m2 ), ICU admission and advanced pathological TNM stages (II and III) are independent risk factors for CSS in EGC patients after curative gastrectomy. Nutrition support, better perioperative management and early diagnosis would be helpful for better survival.

Keyword

Stomach neoplasms; aged; risk factors; survival; body mass index

Figure

  • Fig. 1 Flow diagram shows inclusion and exclusion criteria of patients and study design. Missing data refers to loss of pathological, laboratory tests or surgical records.GC, gastric cancer; GIST, gastrointestinal stromal tumor; ESD, endoscopic submucosal dissection; TSS, tumor-specific survival.

  • Fig. 2 (A) ROC curve showed the predictive accuracy of BMI values for tumor-specific survival. AUC was 0.61 (95% CI, 0.53–0.69, P = 0.006). Youden index was 0.21, sensitivity was 0.43 and specificity was 0.79. The BMI cut-off value was 20.65 kg/m2. (B) TSS was compared between low BMI and high BMI groups using the novel cut-off value, 20.6 kg/m2, in Kaplan-Meier method. Log-rank test was performed and χ2 was 16.27, P < 0.001.ROC, receiver operating curve; BMI, body mass index; AUC, area under curve; CI, confidence interval; TSS, tumor-specific survival.


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