Impact of frailty on outcomes in older patients after curative gastrectomy for cancer: a matched-pair analysis.
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Dal Cero Mariagiulia, Martí-Gelonch Laura, Eizaguirre Emma, Salvador Helena, Yarnoz Concepción, Miranda Coro, Estremiana Fernando, Miró Mónica, Castro Sandra, Gantxegi Amaia, Gil-Albarellos Rafael, García-Tejero Aitana, Olona Carles, Sarriugarte Aingeru, Codony Clara, Viciano Marta, Garsot Elisenda, Aldeano Aurora, Montmany Sandra, Luna Alexis, Pulido Laura, Puértolas Noelia, Sánchez-Cano Juan J, Gobbini Yanina, Hermoso Judit, Pi-Figueras María, Gimeno Marta, Gibert Joan, Manterola Carlos, Grande Luis, Pera Manuel, Spanish EURECCA Esophagogastric Cancer Group
Аннотация
MATERIALS AND METHODS: Prospective cohort study and matched-pair analysis of gastric cancer patients aged 70 years or older undergoing elective curative gastrectomy between March 2019 and March 2022. Frailty was assessed within 2 weeks preoperatively using the modified Frailty Index (mFI-11) with a threshold mFI-11 of 0.27. Matched-pair analysis assessed the strength of the association between frailty and outcomes after adjusting for confounding variables, including age, sex, body mass index, serum albumin, cT stage, neoadjuvant therapy, surgical approach, type of gastrectomy, and surgical radicality.
RESULTS: The study identified 432 patients (63.9% males, mean age 78.6 years), 92 of which showed an mF-11 score ≥ 0.27, with a prevalence of frailty of 21%. Frail patients showed a higher risk of 90-day mortality (RR, 12.0; 95% CI, 1.59-90.40), higher rate of complications (RR, 1.55; 95% CI, 1.11-2.15), major complications (RR, 2.27; 95% CI, 1.19-4.34), failure to rescue (RR, 6.24; 95% CI, 1.91-42.85), and failure to rescue-surgical (RR, 6.29; 95% CI, 1.87-45.33). Frailty was also associated with higher 30-day and 1-year mortality, but differences in conditional survival were not found. Frail patients showed meaningful improvements in health-related quality of life at 1 year.
CONCLUSION: Frailty is a significant risk factor of early postoperative mortality and morbidity in elderly gastric cancer patients, highlighting a critical window for targeted interventions in this cohort.
GOV ID: NCT03568110.