Prognostic value of 11-factor modified frailty index in postoperative adverse outcomes of elderly gastric cancer patients in China

作     者：Zi-Yao Xu Xin-Yu Hao Di Wu Qi-Ying Song Xin-Xin Wang 

作者机构：Department of General SurgeryThe First Medical Center of Chinese PLA General HospitalBeijing 100853China Department of AnesthesiologyThe First Medical Center of Chinese PLA General HospitalBeijing 100853China 

出 版 物：《World Journal of Gastrointestinal Surgery》 (世界胃肠外科杂志（英文版）（电子版）)

年 卷 期：2023年第15卷第6期

页      面：1093-1103页

核心收录：

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Gastric cancer Frailty Mortality Anastomotic fistula Elderly 

摘      要：BACKGROUND Preoperative evaluation of frailty is limited to a few surgical procedures.However,the evaluation in Chinese elderly gastric cancer(GC)patients remains blank.AIM To validate and estimate the prognostic value of the 11-index modified frailty index(mFI-11)for predicting postoperative anastomotic fistula,intensive care unit(ICU)admission,and long-term survival in elderly patients(over 65 years of age)undergoing radical GC.METHODS This study was a retrospective cohort study which included patients who underwent elective gastrectomy with D2 Lymph node dissection between April 1,2017 and April 1,2019.The primary outcome was 1-year all-cause mortality.The secondary outcomes were admission to ICU,anastomotic fistula,and 6-mo mortality.Patients were divided into two groups according to the optimal grouping cutoff of 0.27 points from previous studies:High risk of frailty marked as mFI-11High and low risk of frailty marked as mFI-11Low.Survival curves between the two groups were compared,and univariate and multivariate regression analyses were performed to explore the relationship between preoperative frailty and postoperative complications in elderly patients undergoing radical GC.The discrimination ability of the mFI-11,prognostic nutritional index,and tumornode-metastasis pathological stage to identify adverse postoperative outcomes was assessed by calculating the area under the receiver operating characteristic(ROC)curve.RESULTS A total of 1003 patients were included,of which 13.86%(139/1003)were defined as having mFI-11High and 86.14%(864/1003)as having mFI-11Low.By comparing the incidence of postoperative complications in the two groups of patients,it was found that mFI-11High patients had higher rates of 1-year postoperative mortality,admission to ICU,anastomotic fistula,and 6-mo mortality than the mFI-11Low group(18.0%vs 8.9%,P=0.001;31.7%vs 14.7%,P0.001;7.9%vs 2.8%,P0.001;and 12.2%vs 3.6%,P0.001).Multivariate analysis revealed mFI-11 as an independent predictive indicator for postoperative outcome[1-year postoperative mortality:Adjusted odds ratio(aOR)=4.432,95%confidence interval(95%CI):2.599-6.343,P=0.003;admission to ICU:aOR=2.058,95%CI:1.188-3.563,P=0.010;anastomotic fistula:aOR=2.852,95%CI:1.357-5.994,P=0.006;6-mo mortality:aOR=2.438,95%CI:1.075-5.484,P=0.033].mFI-11 showed better prognostic efficacy in predicting 1-year postoperative mortality[area under the ROC curve(AUROC):0.731],admission to ICU(AUROC:0.776),anastomotic fistula(AUROC:0.877),and 6-mo mortality(AUROC:0.759).CONCLUSION Frailty as measured by mFI-11 could provide prognostic information for 1-year postoperative mortality,admission to ICU,anastomotic fistula,and 6-mo mortality in patients over 65 years old undergoing radical GC.