Nutrition Research and Practice

The Korean Nutrition Society (한국영양학회)
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Risk factors for cancer-specific survival in elderly gastric cancer patients after curative gastrectomy

  • Liu, Xiao (Department of Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College) ;
  • Xue, Zhigang (Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College) ;
  • Yu, Jianchun (Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College) ;
  • Ma, Zhiqiang (Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College) ;
  • Kang, Weiming (Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College) ;
  • Ye, Xin (Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College) ;
  • Li, Zijian (Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College)
  • Received : 2021.09.13
  • Accepted : 2022.01.07
  • Published : 2022.10.01
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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/m2. Multivariate analysis indicated that a BMI ≤ 20.6 kg/m2 (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.

Keywords

Acknowledgement

We appreciated Dr. Guangyu Hu, from Institution of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, for his thoughtful supervision of statistical analyses.

References

  1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394-424. https://doi.org/10.3322/caac.21492
  2. Van Cutsem E, Sagaert X, Topal B, Haustermans K, Prenen H. Gastric cancer. Lancet 2016;388:2654-64. https://doi.org/10.1016/S0140-6736(16)30354-3
  3. Chen WQ, Zheng RS, Zhang SW, Zeng HM, Zou XN, He J. Analysis of cancer incidence and mortality in elderly population in China, 2013. Zhonghua Zhong Liu Za Zhi 2017;39:60-6.
  4. Leo S, Accettura C, Gnoni A, Licchetta A, Giampaglia M, Mauro A, Saracino V, Carr BI. Systemic treatment of gastrointestinal cancer in elderly patients. J Gastrointest Cancer 2013;44:22-32. https://doi.org/10.1007/s12029-012-9447-5
  5. Saito H, Osaki T, Murakami D, Sakamoto T, Kanaji S, Tatebe S, Tsujitani S, Ikeguchi M. Effect of age on prognosis in patients with gastric cancer. ANZ J Surg 2006;76:458-61. https://doi.org/10.1111/j.1445-2197.2006.03756.x
  6. Hall PS, Lord SR, Collinson M, Marshall H, Jones M, Lowe C, Howard H, Swinson D, Velikova G, Anthoney A, et al. A randomised phase II trial and feasibility study of palliative chemotherapy in frail or elderly patients with advanced gastroesophageal cancer (321GO). Br J Cancer 2017;116:472-8. https://doi.org/10.1038/bjc.2016.442
  7. Takama T, Okano K, Kondo A, Akamoto S, Fujiwara M, Usuki H, Suzuki Y. Predictors of postoperative complications in elderly and oldest old patients with gastric cancer. Gastric Cancer 2015;18:653-61. https://doi.org/10.1007/s10120-014-0387-6
  8. Takeuchi D, Koide N, Suzuki A, Ishizone S, Shimizu F, Tsuchiya T, Kumeda S, Miyagawa S. Postoperative complications in elderly patients with gastric cancer. J Surg Res 2015;198:317-26. https://doi.org/10.1016/j.jss.2015.03.095
  9. Kim DH, Kim SM, Hyun JK, Choi MG, Noh JH, Sohn TS, Bae JM, Kim S. Changes in postoperative recurrence and prognostic risk factors for patients with gastric cancer who underwent curative gastric resection during different time periods. Ann Surg Oncol 2013;20:2317-27. https://doi.org/10.1245/s10434-012-2700-0
  10. Sarfati D, Blakely T, Pearce N. Measuring cancer survival in populations: relative survival vs cancerspecific survival. Int J Epidemiol 2010;39:598-610. https://doi.org/10.1093/ije/dyp392
  11. Edwards BK, Noone AM, Mariotto AB, Simard EP, Boscoe FP, Henley SJ, Jemal A, Cho H, Anderson RN, Kohler BA, et al. Annual report to the nation on the status of cancer, 1975-2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer. Cancer 2014;120:1290-314. https://doi.org/10.1002/cncr.28509
  12. Sarfati D, Koczwara B, Jackson C. The impact of comorbidity on cancer and its treatment. CA Cancer J Clin 2016;66:337-50. https://doi.org/10.3322/caac.21342
  13. Lee L, Cheung WY, Atkinson E, Krzyzanowska MK. Impact of comorbidity on chemotherapy use and outcomes in solid tumors: a systematic review. J Clin Oncol 2011;29:106-17.
  14. Lacau St Guily J, Bouvard E, Raynard B, Goldwasser F, Maget B, Prevost A, Seguy D, Romano O, Narciso B, Couet C, et al. NutriCancer: a French observational multicentre cross-sectional study of malnutrition in elderly patients with cancer. J Geriatr Oncol 2018;9:74-80. https://doi.org/10.1016/j.jgo.2017.08.003
  15. Kim CY, Kim SY, Song JH, Kim YS, Jeong SJ, Lee JG, Paik HC, Park MS. Usefulness of the preoperative prognostic nutritional index score as a predictor of the outcomes of lung transplantation: a singleinstitution experience. Clin Nutr 2019;38:2423-9. https://doi.org/10.1016/j.clnu.2018.10.027
  16. Fukuda Y, Yamamoto K, Hirao M, Nishikawa K, Maeda S, Haraguchi N, Miyake M, Hama N, Miyamoto A, Ikeda M, et al. Prevalence of malnutrition among gastric cancer patients undergoing gastrectomy and optimal preoperative nutritional support for preventing surgical site infections. Ann Surg Oncol 2015;22 Suppl 3:S778-85.
  17. Rosania R, Chiapponi C, Malfertheiner P, Venerito M. Nutrition in patients with gastric cancer: an update. Gastrointest Tumors 2016;2:178-87.
  18. Zheng HL, Lu J, Li P, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Lin M, Tu R, et al. Effects of preoperative malnutrition on short- and long-term outcomes of patients with gastric cancer: can we do better? Ann Surg Oncol 2017;24:3376-85. https://doi.org/10.1245/s10434-017-5998-9
  19. Kurita N, Miyata H, Gotoh M, Shimada M, Imura S, Kimura W, Tomita N, Baba H, Kitagawa Y, Sugihara K, et al. Risk model for distal gastrectomy when treating gastric cancer on the basis of data from 33,917 Japanese patients collected using a nationwide web-based data entry system. Ann Surg 2015;262:295-303. https://doi.org/10.1097/SLA.0000000000001127
  20. Kunisaki C, Miyata H, Konno H, Saze Z, Hirahara N, Kikuchi H, Wakabayashi G, Gotoh M, Mori M. Modeling preoperative risk factors for potentially lethal morbidities using a nationwide Japanese web-based database of patients undergoing distal gastrectomy for gastric cancer. Gastric Cancer 2017;20:496-507. https://doi.org/10.1007/s10120-016-0634-0
  21. Kikuchi H, Miyata H, Konno H, Kamiya K, Tomotaki A, Gotoh M, Wakabayashi G, Mori M. Development and external validation of preoperative risk models for operative morbidities after total gastrectomy using a Japanese web-based nationwide registry. Gastric Cancer 2017;20:987-97. https://doi.org/10.1007/s10120-017-0706-9
  22. Hartgrink HH, van de Velde CJ, Putter H, Bonenkamp JJ, Klein Kranenbarg E, Songun I, Welvaart K, van Krieken JH, Meijer S, Plukker JT, et al. Extended lymph node dissection for gastric cancer: who may benefit? Final results of the randomized Dutch gastric cancer group trial. J Clin Oncol 2004;22:2069-77. https://doi.org/10.1200/JCO.2004.08.026
  23. Liu X, Xue Z, Yu J, Li Z, Ma Z, Kang W, Ye X, Jiang L. Risk factors for postoperative infectious complications in elderly patients with gastric cancer. Cancer Manag Res 2020;12:4391-8. https://doi.org/10.2147/CMAR.S253649
  24. Hall WH, Ramachandran R, Narayan S, Jani AB, Vijayakumar S. An electronic application for rapidly calculating Charlson comorbidity score. BMC Cancer 2004;4:94.
  25. Washington K. 7th edition of the AJCC cancer staging manual: stomach. Ann Surg Oncol 2010;17:3077-9. https://doi.org/10.1245/s10434-010-1362-z
  26. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z; Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr 2003;22:321-36. https://doi.org/10.1016/S0261-5614(02)00214-5
  27. Park HA, Park SH, Cho SI, Jang YJ, Kim JH, Park SS, Mok YJ, Kim CS. Impact of age and comorbidity on the short-term surgical outcome after laparoscopy-assisted distal gastrectomy for adenocarcinoma. Am Surg 2013;79:40-8.
  28. Mizuno A, Kanda M, Kobayashi D, Tanaka C, Iwata N, Yamada S, Fujii T, Nakayama G, Sugimoto H, Koike M, et al. Adverse effects of intraoperative blood loss on long-term outcomes after curative gastrectomy of patients with stage II/III gastric cancer. Dig Surg 2016;33:121-8. https://doi.org/10.1159/000443219
  29. Kim CH, Park SM, Kim JJ. The impact of preoperative low body mass index on postoperative complications and long-term survival outcomes in gastric cancer patients. J Gastric Cancer 2018;18:274-86. https://doi.org/10.5230/jgc.2018.18.e30
  30. Liu BZ, Tao L, Chen YZ, Li XZ, Dong YL, Ma YJ, Li SG, Li F, Zhang WJ. Preoperative body mass index, blood albumin and triglycerides predict survival for patients with gastric cancer. PLoS One 2016;11:e0157401.
  31. Feng F, Zheng G, Guo X, Liu Z, Xu G, Wang F, Wang Q, Guo M, Lian X, Zhang H. Impact of body mass index on surgical outcomes of gastric cancer. BMC Cancer 2018;18:151.
  32. Zhao B, Zhang J, Zhang J, Zou S, Luo R, Xu H, Huang B. The impact of preoperative underweight status on postoperative complication and survival outcome of gastric cancer patients: a systematic review and meta-analysis. Nutr Cancer 2018;70:1254-63.
  33. Lee HH, Park JM, Song KY, Choi MG, Park CH. Survival impact of postoperative body mass index in gastric cancer patients undergoing gastrectomy. Eur J Cancer 2016;52:129-37. https://doi.org/10.1016/j.ejca.2015.10.061
  34. Ejaz A, Spolverato G, Kim Y, Poultsides GA, Fields RC, Bloomston M, Cho CS, Votanopoulos K, Maithel SK, Pawlik TM. Impact of body mass index on perioperative outcomes and survival after resection for gastric cancer. J Surg Res 2015;195:74-82. https://doi.org/10.1016/j.jss.2014.12.048
  35. Bahat G, Tufan F, Saka B, Akin S, Ozkaya H, Yucel N, Erten N, Karan MA. Which body mass index (BMI) is better in the elderly for functional status? Arch Gerontol Geriatr 2012;54:78-81. https://doi.org/10.1016/j.archger.2011.04.019
  36. Rondel ALMA, Langius JAE, de van der Schueren MAE, Kruizenga HM. The new ESPEN diagnostic criteria for malnutrition predict overall survival in hospitalised patients. Clin Nutr 2018;37:163-8. https://doi.org/10.1016/j.clnu.2016.11.018
  37. Cederholm T, Bosaeus I, Barazzoni R, Bauer J, Van Gossum A, Klek S, Muscaritoli M, Nyulasi I, Ockenga J, Schneider SM, et al. Diagnostic criteria for malnutrition - an ESPEN consensus statement. Clin Nutr 2015;34:335-40. https://doi.org/10.1016/j.clnu.2015.03.001
  38. Guo W, Ou G, Li X, Huang J, Liu J, Wei H. Screening of the nutritional risk of patients with gastric carcinoma before operation by NRS 2002 and its relationship with postoperative results. J Gastroenterol Hepatol 2010;25:800-3. https://doi.org/10.1111/j.1440-1746.2009.06198.x
  39. Qiu M, Zhou YX, Jin Y, Wang ZX, Wei XL, Han HY, Ye WF, Zhou ZW, Zhang DS, Wang FH, et al. Nutrition support can bring survival benefit to high nutrition risk gastric cancer patients who received chemotherapy. Support Care Cancer 2015;23:1933-9. https://doi.org/10.1007/s00520-014-2523-6
  40. Jiang N, Deng JY, Ding XW, Ke B, Liu N, Zhang RP, Liang H. Prognostic nutritional index predicts postoperative complications and long-term outcomes of gastric cancer. World J Gastroenterol 2014;20:10537-44. https://doi.org/10.3748/wjg.v20.i30.10537
  41. Sakurai K, Ohira M, Tamura T, Toyokawa T, Amano R, Kubo N, Tanaka H, Muguruma K, Yashiro M, Maeda K, et al. Predictive potential of preoperative nutritional status in long-term outcome projections for patients with gastric cancer. Ann Surg Oncol 2016;23:525-33. https://doi.org/10.1245/s10434-015-4814-7
  42. Tateishi R, Yoshida H, Shiina S, Imamura H, Hasegawa K, Teratani T, Obi S, Sato S, Koike Y, Fujishima T, et al. Proposal of a new prognostic model for hepatocellular carcinoma: an analysis of 403 patients. Gut 2005;54:419-25. https://doi.org/10.1136/gut.2003.035055
  43. Esfahani A, Makhdami N, Faramarzi E, Asghari Jafarabadi M, Ostadrahimi A, Ghayour Nahand M, Ghoreishi Z. Prealbumin/CRP based prognostic score, a new tool for predicting metastasis in patients with inoperable gastric cancer. Gastroenterol Res Pract 2016;2016:4686189.
  44. Fujisaki M, Shinohara T, Hanyu N, Kawano S, Tanaka Y, Watanabe A, Yanaga K. Laparoscopic gastrectomy for gastric cancer in the elderly patients. Surg Endosc 2016;30:1380-7. https://doi.org/10.1007/s00464-015-4340-5
  45. Frenkel WJ, Jongerius EJ, Mandjes-van Uitert MJ, van Munster BC, de Rooij SE. Validation of the Charlson comorbidity index in acutely hospitalized elderly adults: a prospective cohort study. J Am Geriatr Soc 2014;62:342-6. https://doi.org/10.1111/jgs.12635
  46. Iwai N, Dohi O, Naito Y, Inada Y, Fukui A, Takayama S, Ogita K, Terasaki K, Nakano T, Ueda T, et al. Impact of the Charlson comorbidity index and prognostic nutritional index on prognosis in patients with early gastric cancer after endoscopic submucosal dissection. Dig Endosc 2018;30:616-23. https://doi.org/10.1111/den.13051