Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2023; 15(6): 1093-1103
Published online Jun 27, 2023. doi: 10.4240/wjgs.v15.i6.1093
Prognostic value of 11-factor modified frailty index in postoperative adverse outcomes of elderly gastric cancer patients in China
Zi-Yao Xu, Xin-Yu Hao, Di Wu, Qi-Ying Song, Xin-Xin Wang
Zi-Yao Xu, Di Wu, Qi-Ying Song, Xin-Xin Wang, Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
Xin-Yu Hao, Department of Anesthesiology, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
Author contributions: Xu ZY and Hao XY contributed equally to this work; Xu ZY, Hao XY, and Wang XX designed the experiments; Wu D performed the experiments; Xu ZY and Hao XY collected the data; Wu D and Song QY analyzed the data; Xu ZY, Hao XY, and Wang XX wrote the initial draft; Wu D and Song QY modified the manuscript.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Chinese PLA General Hospital (approval No. S2021-342-01).
Conflict-of-interest statement: All authors declare that there is no conflict of interest to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xin-Xin Wang, MD, PhD, Assistant Professor, Chief Doctor, Department of General Surgery, The First Medical Center of Chinese PLA General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. 301wxx@sina.com
Received: January 30, 2023
Peer-review started: January 30, 2023
First decision: March 13, 2023
Revised: March 15, 2023
Accepted: April 12, 2023
Article in press: April 12, 2023
Published online: June 27, 2023
Processing time: 136 Days and 9.2 Hours
Abstract
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 tumor-node-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%, P < 0.001; 7.9% vs 2.8%, P < 0.001; and 12.2% vs 3.6%, P < 0.001). 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.

Keywords: Gastric cancer; Frailty; Mortality; Anastomotic fistula; Elderly

Core Tip: Frailty is becoming an increasingly established risk factor for adverse postoperative outcomes. Given the innately high morbidity involved in radical gastric cancer and the propensity for comorbidities among this patient population, we sought to validate and estimate the prognostic value of the 11-index modified frailty index (mFI-11) in the postoperative period and long-term survival of those patients. The mFI-11 has proven to be a potential exponential tool that can easily stratify patients, predict long-term outcomes, and add value to future treatments.