Impact of Combined Frailty and Sarcopenia on Postoperative Outcomes and Survival in Elderly Gastric Cancer Patients Undergoing Gastrectomy.

PURPOSE: Frailty and sarcopenia are associated with adverse postoperative outcomes in elderly patients undergoing gastrectomy for gastric cancer. However, large-scale evidence remains limited. This study aimed to investigate the associations of frailty and sarcopenia with postoperative outcomes and long-term survival in this population.

MATERIALS AND

METHODS

This retrospective study included patients aged ≥70 years who underwent gastrectomy for gastric cancer between December 2011 and May 2021 and had preoperative comprehensive geriatric assessment and abdominal computed tomography. Frailty was defined as a multidimensional frailty score >6, and sarcopenia was defined as the L3 skeletal muscle index in the lowest tertile for each sex. The patients were categorized as non-frail/non-sarcopenic (NF/NS), frail or sarcopenic (F or S), or frail and sarcopenic (F/S).

RESULTS

A total of 508 patients (mean age, 77.6±4.6 years; 64.0% male) were analyzed. Eighty-two patients (16.1%) experienced Clavien-Dindo grade ≥II complications within 30 days. In multivariable logistic regression analysis, the F/S group was an independent predictor of postoperative complications (odds ratio, 2.73; 95% confidence interval [CI], 1.07-6.98; P=0.036). In multivariable Cox regression analysis, both the F or S and F/S groups showed significantly worse overall survival (hazard ratio [HR], 2.17 and 3.11, respectively; both P<0.001). The F/S group showed significantly worse cancer-specific survival (HR, 2.46; 95% CI, 1.02-5.93; P=0.046).

CONCLUSIONS

Combined frailty and sarcopenia were independently associated with worse postoperative outcomes and survival in elderly patients with gastric cancer. Either condition alone was also associated with worse overall survival, suggesting a dose-response relationship and highlighting the importance of comprehensive geriatric assessment.