A tale of two tracts: Comparison of the survival rates of upper and lower GIT cancers by age, gender, and handgrip strength in geriatric population from 12 European countries

A tale of two tracts: Comparison of the survival rates of upper and lower GIT cancers by age, gender, and handgrip strength in geriatric population from 12 European countries | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A tale of two tracts: Comparison of the survival rates of upper and lower GIT cancers by age, gender, and handgrip strength in geriatric population from 12 European countries Salman Yousuf Guraya, Rizwan Qaisar, M. Azhar Hussain This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7839736/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 14 You are reading this latest preprint version Abstract Background Gastrointestinal tract (GIT) cancers are among the most prevalent malignancies worldwide. Due to variations in anatomical locations and biological behaviors of upper and lower GIT cancers, differences exist in their survival and physical capacity domains. Limited large-scale comparative datasets exist for upper and lower GIT cancers, particularly in the geriatric population. This study aimed to compare survival rates and handgrip strength (HGS) between upper and lower GIT cancer European geriatric patients, with specific attention to age and gender differences. Methods This longitudinal cohort study used data about the European geriatric population from the Survey of Health, Ageing, and Retirement in Europe (SHARE) across waves 4 to 9. HGS was measured using a dynamometer. Regression analysis was performed using the survival methodology with a Weibull distribution adjusted for age, gender, and HGS. Results A total of 33,379 adults aged ≥ 50 were included, comprising 106 participants with upper GIT cancer and 99 with lower GIT cancer. Overall, nine-year survival was 39.6% for upper GIT and 34.3% for lower GIT cancer patients. Lower GIT cancer was associated with significantly higher mortality risk (β = 0.579, p < 0.001). Female gender conferred a protective effect (β = -0.215, p < 0.001), with women showing notably better survival than men in the lower GIT group. Advanced age (≥ 80 years) significantly increased mortality risk (β = 1.105, p < 0.001). Higher HGS was associated with longer survival (β = -0.365, p < 0.001), particularly in upper GIT cancers. Conclusion In this study, patients with lower GIT cancers had worse survival compared to upper GIT cancers, particularly among older men with low HGS. Women with lower GIT cancers had a survival advantage over men, while HGS had a stronger positive predictive value in upper GIT cancers. These distinctions call for personalized and targeted assessment and management plans for GIT cancers. Gastrointestinal cancer handgrip strength physical capacity SHARE survival Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Gastrointestinal tract (GIT) cancers have a high incidence rate and mortality, accounting for 5.1 million new cases and 3.6 million new deaths in 2020 worldwide [ 1 ]. These cancers may primarily be classified as cancers of the upper (oral cavity, pharynx, esophagus, stomach, liver, and pancreas) and lower (colorectal) cancers. Both cancers have unique epidemiology, risk factors, and clinical outcomes. Such variation is evident by different 5-year survival rates; 65% for colorectal cancers and 33%, 21%, and 12% for gastric, esophageal, and pancreatic cancers, respectively [ 2 ]. According to the available evidence in medicine, the treatment efficacy of GIT cancers is primarily determined by survival rates and cancer-related signs and symptoms, while overlooking the physical capacity of the patients. The physical capacity of patients with GIT cancers is a significant determinant of their prognosis and survival and, to some extent, signifies the outcomes of management plans [ 3 ]. Most GIT cancers, their surgical therapies, and chemotherapies cause significant myotoxicity with adverse effects on the physical independence of the patients [ 4 ]. Specifically, these patients face difficulty in performing physical activities, such as toileting, walking, dressing, and rising from a chair. The impairment of such activities is established as an independent risk factor for recurrence and mortality of patients with lower GIT cancers [ 5 ]. Therefore, it may be imperative to monitor the physical independence and activities of daily living in GIT cancer patients as markers of disease progression. However, the relevant data is often self-reported and have considerable subjective variability. The handgrip strength (HGS) objectively measures the quality of skeletal muscle in cancer patients [ 6 ]. HGS is adversely affected by chemotherapy in GIT cancers and can be a reliable tool to predict postoperative complications [ 7 ] and survival [ 8 ] in GIT cancer. Thus, for GIT cancers, a combination of HGS with the activities of daily living may provide a comprehensive assessment of physical capacity of the affected patients. In GIT cancers, it may be critical to integrate physical capacity with the clinical efficacy of various therapies to obtain a broader perspective on the disease progression. However, several covariates, such as assessment settings (domestic versus clinical), demography and age of patients, racial and ethnic profiles, and socioeconomic status, may each influence the physical capacity of such cohort of patients. However, most relevant studies are performed in the context of regional settings and may not provide a representative dataset. The evaluation of a large dataset of patients with statistical adjustment for covariates may provide more relevant results for physical capacity. In our study, we used the dataset from the standardized Survey of Health, Ageing, and Retirement in Europe (SHARE), which contains a repository of the longitudinally conducted panel of geriatric adults aged 50 or above across multiple European countries [ 9 ]. We compared and analysed age and gender specific data of patients with upper and lower GIT cancers for difficulties performing various routine physical activities, HGS, and survival rates after diagnosis. We hypothesized that the patients with upper GIT cancers exhibit more significant difficulties in performing activities of daily living, and reduced HGS than those with upper GIT cancers. Materials and methods The study includes the geriatric population from the SHARE survey, a representative multi-disciplinary panel data study of individuals aged at least 50 years [ 9 ]. SHARE is an international collaborative effort involving nearly all European countries that collects comprehensive data through in-person interviews. The individual-level information covers important dimensions of respondents’ life-stories, including demographic characteristics, socioeconomic conditions, living arrangements, and aspects of the public and personal health situation. The baseline data for this study were obtained from the fifth wave of SHARE conducted in 2013. Still, information from wave 4 (interviews during 2010–2012) was also included: only people without cancer in wave 4 and diagnosed with cancer in wave 5 were included. Subsequent waves, namely wave 6 (2015), wave 7 (2017), wave 8 (2019/2020), and wave 9 (2021/2022), served as follow-up surveys, allowing for the examination of changes over time. SHARE study wave 5 collected information on cancer in the questionnaire, after showing the respondent a list of 20 diseases/2 other options, where cancer was identified through the question: “Has a doctor ever told you that you had/Do you currently have any of the conditions on this card? With this we mean that a doctor has told you that you have this condition, and that you are either currently being treated for or bothered by this condition Please tell me the number or numbers of the conditions”. Among the possible answers were: “Cancer or malignant tumor, including leukemia or lymphoma, but excluding minor skin cancers”. If cancer was chosen the respondent was asked: “In which organ or part of the body have you or have you had cancer?”. Possible answers included 22 specific organs and the category “other organ”. Upper GIT cancer is present when the respondent chooses the following six organs: Oral cavity, other pharynx, esophagus, stomach, liver, or pancreas. Lower GIT cancer is present when the respondent said the organ was: the colon or the rectum. Subjects were followed in subsequent waves 6, 7, 8, and 9, and it was identified when the person was no longer in the survey due to death. It was thus possible to estimate for how long subjects survived after being diagnosed with a specific type of the two mentioned cancers for those who died during waves 6–9. The rest are right-censored, i.e., they were still alive in wave 9 but will eventually pass away. This censoring means that traditional regression methodologies cannot be applied, and we estimate the survival of patients using duration analysis. HGS was measured using a hand-held dynamometer (Smedley, S Dynamometer, TTM, Tokyo, 100 kg) [ 10 ]. Patients with swelling or inflammation, severe pain or recent injury, or a recent surgery to the hand were excluded from the study. Participants were instructed to press the dynamometer with their left and right hands, performing two repetitions with each hand. If a participant could not use with one hand, measurements were only taken from the other hand. The test instructions required the participants to maintain an upright posture with their upper arm parallel to their torso and their lower arm perpendicular to their torso. If necessary, the test could also be performed in a sitting position. The highest recorded value from these four measurements was used in the subsequent analysis. Low HGS was defined based on gender-specific thresholds, following the guidelines by the European Working Group on Sarcopenia in Older People (EWGSOP2), with thresholds of 27 KG for males and 16 KG for females [ 11 ]. Statistical analysis Multiple regression analyses were applied to identify individual characteristics affecting survival after a specific cancer diagnosis. Time t (years) to death was statistically modelled as $$\:\text{ln}t={\beta\:}_{0}+{\beta\:}_{1}Female+AgeGroups{\beta\:}_{2}+HGSGroups{\beta\:}_{3}+z$$ where: Female = 1 if the respondent was a female (and 0 for base category males); age group dummies are 60–69 years, 70–79 years, and 80 + years (50–59 years is the base category); HGS groups are low HGS and missing HGS (high HGS is the base category). Coefficients (vectors) β1, β2, and β3 represent effect on survival for the three individual characteristics. The z term is the error following the f(.) distribution with an extreme-value density yielding the Weibull regression model (and exponential model). The hazard (empirically, probability of death at time t , given survival till time t ) h and survival (empirically, the probability of survival at time t ) S functions are $$\:h\left(t\right)=p{\bullet\:\lambda\:\bullet\:t}^{p-1}\:\text{a}\text{n}\text{d}\:S\left(t\right)={e}^{-\lambda\:\bullet\:{t}^{p}}\:,\:\lambda\:={e}^{-p\bullet\:\varvec{x}\varvec{\beta\:}}$$ where the shape parameter p is estimated from the data (σ = 1/ p ). All statistical analyses were performed with the software package STATA 18.0 SE Standard Edition (Release 18. College Station, TX: StataCorp LLC) using the Stata commands stset, sts graph, streg, margins, and marginsplot. Results Demographic characteristics of participants Table 1 presents summary statistics for individuals categorized into three groups: those with no cancer, those with upper GIT cancer, and those with lower GIT cancer. This table includes data on gender, age, handgrip strength from wave 5, and survival at the last recorded waves 6-9. Regarding gender distribution, among individuals without cancer, 43.0% were men and 57.0% were women. In contrast, among those with upper GIT cancer, 53.8% were men and 46.2% were women, while for lower GIT cancer, there were 59.6% men and 40.4% women. Regarding age distribution, most individuals were in the 60-69 age group across all cancer categories. The HGS data analysis showed that most individuals had high strength, but a higher percentage of GIT cancer patients had low strength than those without cancer. Some HGS data were missing, particularly in the lower GIT cancer group. Survival status showed that a more significant proportion of GIT cancer patients passed away compared to those without cancer. The percentage of deceased individuals was highest in the lower GIT cancer group (65.7%), followed by the upper GIT cancer group (60.4%). No cancer Upper GIT cancer Lower GIT cancer All n % n % n % n % Gender Male 14,338 43.2 57 53.8 59 59.6 14,454 43.3 Female 18,836 56.8 49 46.2 40 40.4 18,925 56.7 Age 50-59 10,436 31.5 14 13.2 23 23.2 10,473 31.4 60-69 11,512 34.7 36 34.0 34 34.3 11,582 34.7 70-79 7,998 24.1 39 36.8 31 31.3 8,068 24.2 80+ 3,228 9.7 17 16.0 11 11.1 3,256 9.8 Handgrip strength Low 2,117 6.4 13 12.3 5 5.1 2,135 6.4 High 28,773 86.7 85 80.2 85 85.9 28,943 86.7 Missing 2,284 6.9 8 7.5 9 9.1 2,301 6.9 Survival at last wave Passed away 16,438 49.6 64 60.4 65 65.7 16,567 49.6 Alive 16,736 50.4 42 39.6 34 34.3 16,812 50.4 Total 33,174 100 106 100 99 100 33,379 100 Source: Own calculations based on SHARE-ERIC datasets from waves 4-9. Table 1 . Summary statistics of the study population. Kaplan-Meier survival results In Figure 1 , the Kaplan-Meier survival curve illustrates the survival probabilities over nine years for individuals with no cancer, lower GIT, and upper GIT cancer. The y-axis represents survival probability from 1.0 (100%) to 0.0 (0%), while the x-axis shows years of survival. All groups start at a survival probability 1.0, meaning 100% of individuals were alive initially. However, survival probabilities declined over time, with apparent differences between groups. By year 3, about 80% of individuals without cancer remained alive, while survival for lower GIT cancer was approximately 70%, and upper GIT cancer survival dropped below 60%. By year 6, survival for upper GIT cancer dropped to almost 40%, while lower GIT cancer remained slightly higher at about 50%. Lastly, by year 9, survival for the no-cancer group remained above 50%, while the lower and upper GIT cancer groups dropped below 40%. Regression of survival time Table 2 outlines the results of survival regression analysis using the Weibull distribution, focusing on how cancer type, gender, age, and HGS affected survival outcomes across various subgroups. The coefficients represent the relationship between each factor and the risk of the event, with significance levels indicated by asterisks. The analysis showed that upper GIT cancer was associated with an increased risk in the overall population. In column one, the coefficient for upper GIT cancer is 0.334**, which indicates a statistically significantly higher risk of death for individuals with upper GIT cancer. In column one for lower GIT cancer, the coefficient is 0.578***, statistically significant at the 1% level. Regarding gender, women were generally associated with a lower risk of death. In column one, the coefficient for women was -0.218***, indicating a significant protective effect compared to men. This negative association was more pronounced in other subgroups, such as column 6 (HGS included continuously), where the coefficient was -2.039***, showing a substantial reduction in risk for women. All All No cancer Upper GIT cancer Lower GIT cancer All Lower GIT cancer (1) (2) (3) (4) (5) (6) (7) Cancer type Upper GIT cancer 0.335** 0.133 0.0976 Lower GIT cancer 0.579*** 0.594*** 0.644*** Gender Female -0.215*** -0.214*** -0.0608 -0.480 -0.544*** -0.979* Age 60-69 -0.00671 -0.0745*** 0.858* 70-79 0.422*** 0.425*** 0.424 0.458 0.286*** 0.661 80+ 1.105*** 1.108*** 0.883* 1.688*** 0.916*** 1.602** Handgrip strength High -0.365*** -0.365*** -0.770 0.525 Missing 0.0744* 0.0765* 0.165 0.161 Continous -0.0206*** -0.0426* ln p 0.173*** 0.216*** 0.218*** 0.194 0.0787 0.222*** 0.140 Sample size 33379 33379 33174 106 99 31078 90 Note: Left out categories are no cancer, male, 50-59 years, and low HGS. * p<0.05, ** p<0.01, *** p<0.001 Table 2. Survival regression analysis for groups with upper and lower GIT cancers and no cancers applying the Weibull distribution. For individuals aged 60-69, the reported coefficient was -0.0596**, suggesting a slight reduction in mortality risk, while those aged 70-79 had a positive coefficient of 0.233***, indicating a higher risk. The coefficient for individuals aged 80 and above was 0.895***, emphasizing an increased risk for older individuals. HGS was associated with a reduced risk. In the All group category, participants with high HGS had a coefficient of -0.416***, suggesting that better physical strength is protective for better survival. Expected survival time Based on the regression analysis results, we can estimate the expected survival of individuals with different demographics and clinical conditions. Figure 2 illustrates the significance of including controls when estimating survival rates in the case of lower GIT cancer. The expected number of survived years differs by more than a year among patients with upper and lower GIT cancers and those without cancers. Figure 3 presents life expectancy after diagnosing different cancers as classified by gender and age in our study. Individuals without cancers had the highest survival, especially among those aged 50-69 years, while older age groups showed a decline in survival rates. Women tend to live slightly longer than men. Upper GIT cancer significantly reduces life expectancy, with younger patients (50-69 years) having better survival than older individuals. Lower GIT cancer showed slightly better survival than upper GIT cancer, though still lower than those without cancer. Age was found to be a critical factor, as survival declined remarkably in individuals over 80 years. There were gender differences with overlapping confidence intervals, but not substantial. Figure 3 highlights the impact of cancer type on survival. Not surprisingly, individuals without cancers maintained the longest life expectancy across all age groups. Figure 4 illustrates the relationship between HGS and life expectancy, analyzed separately by cancer type and gender. The horizontal axis represents HGS, while the vertical axis shows expected years of survival. In panel a, which focuses on cancer type, individuals without cancer had the highest life expectancy across all levels of HGS. Those with upper GIT cancer had lower survival than the no-cancer group, but higher than participants with lower GIT cancer. Across all groups, stronger HGS was associated with more prolonged survival, highlighting the importance of muscle strength as a predictor of longevity. Panel b focuses on gender differences in survival for upper GIT cancer patients. Women consistently had higher survival rates than men at all HGS levels. The survival gap widened as HGS increases, suggesting that muscle strength is more significant in extending life expectancy for women than men. Discussion In our study, the large representative dataset from SHARE highlights several significant findings about survival in patients with upper and lower GIT cancers. We found that the participants diagnosed with lower GIT cancers experienced lower survival than those with upper GIT cancers. Furthermore, our study reported comparable years of survival for both genders following the diagnosis of upper GIT cancer. Women demonstrated significantly longer survival than men following the diagnosis of lower GIT cancer. The HGS at the time of diagnosis of GIT cancers was found to be a critical influencer, with lower HGS predicting shorter survival. Finally, consistent with previous research, increasing age at the time of diagnosis was significantly associated with reduced years of survival. The reduced survival of patients with lower GIT cancers compared to those with upper GIT cancers is consistent with previous reports [ 12 ] [ 13 ]. Thus, the general trend suggests that the anatomical location of the primary tumor significantly influences prognosis. Several factors could contribute to this disparity. Lower GIT cancers often present itself with different patterns of metastasis and may involve distinct molecular subtypes that exhibit varying degrees of aggressiveness [ 14 ]. Moreover, the proximity of lower GIT tumors to critical structures and the potential for complex surgical interventions could also play a role in survival outcomes [ 15 ]. However, it is important to acknowledge that the SHARE data does not provide details about the extent of cancer spread and the quality of therapeutic interventions. The observed gender differences in survival rates following the diagnosis of lower GIT cancer, with women exhibiting a more favorable outcome, is a critical observation in our study. While survival in upper GIT cancers appears to be more similar across genders, the divergence in lower GIT cancers suggests a potential interplay of biological and social factors. Biological factors, such as, variations in tumor biology, have been proposed as potential contributors [ 16 ]. Additionally, social factors, including differences in healthcare-seeking behavior, treatment adherence, and social support networks, may also play a role. Social drivers of health influence each stage of the cancer care continuum, and racial and ethnic minority patients experience higher rates of adverse social effects such as housing insecurity, few educational opportunities, and low socioeconomic status [ 17 ]. The SHARE dataset, while valuable, may not fully capture the complexity of these interactions. Another key finding of our study was that low HGS at the time of GIT cancer diagnosis predicted shorter survival irrespective of the location of the GIT cancer. HGS is a well-established marker of overall muscle strength and functional capacity, and it has been increasingly recognized as a prognostic indicator in various health conditions, including cancer [ 18 ] [ 19 ]. Sarcopenia, the loss of muscle mass and strength, is common in older adults, particularly among those with chronic malignancies [ 20 ]. Reduced HGS is a key indicator of sarcopenia and can reflect a decline in physiological reserve, making individuals more vulnerable to the adverse effects of cancer and its treatment. Our findings are consistent with studies that have shown the presence of other chronic age-related diseases a predictors for poor physical capacity of the affected patients [ 21 ] [ 18 ]. Several mechanisms can explain the prognostic values of HGS in our study cohort. A low HGS is frequently associated with sarcopenia and frailty in old age [ 22 ]. Sarcopenia can likely lead to increased frailty, reduced tolerance to chemotherapy and surgery, and a higher risk of complications. Furthermore, it may be associated with increased inflammation and metabolic dysfunction, which can promote tumor growth and progression. Therefore, our study and the available corpus of literature proposes that the assessment of HGS in older adults diagnosed with GIT cancer can be used as a valuable prognostic indicator that can help clinical decision-making. Additionally, interventions to improve muscle strength and physical function such as exercise programs and nutritional support, may improve survival [ 23 ]. Further, it is essential to consider that GIT cancers can affect nutritional status and metabolic processes differently. Upper GIT cancers may lead to earlier and more severe malnutrition due to difficulties with swallowing and digestion. Conversely, lower GIT cancers may negatively affect nutrient absorption and bowel function. These functional differences caused by structural variations among GIT cancers lead to sarcopenia and low HGS, influencing overall cancer survival. Therefore, it is proposed that exercise therapies and nutritional support in cancer patients may adequately address sarcopenia, improve the response to cancer therapies, and improve the overall survival after diagnosis [ 24 ]. Finally, the finding of our study that increasing age at the time of GIT cancer diagnosis is associated with reduced years of survival corroborates a substantial body of evidence [ 25 ]. Age is a well-established risk factor for cancer development, and older individuals often present with more advanced disease and a greater burden of comorbidities. Older patients may also be less tolerant of aggressive cancer treatments, and their overall physiological reserve may be limited. These factors contribute to poorer outcomes in older cancer patients. Our results highlight the importance of considering age as a critical prognostic factor in managing elderly individuals with GIT cancer [ 26 ]. Therefore, it is crucial to tailor treatment strategies to the specific needs of elderly patients, considering their overall health status, functional capacity, and treatment preferences. Comprehensive geriatric assessments can help identify older patients at higher risk of adverse outcomes and guide the development of individualized treatment plans. Study limitations This study has several limitations. First, the data were derived from self-reported survey responses, which may introduce recall bias or reporting inaccuracies. Second, the SHARE dataset lacks detailed clinical information such as cancer staging, histological subtypes, treatment modalities, and comorbidities, which could affect survival outcomes. Lastly, despite adjustments for key covariates, residual confounding but unmeasured factors such as nutritional status or functional capacity beyond HGS cannot be overlooked. Conclusion Our study, using data from SHARE, provides valuable insights into the factors influencing survival following GIT cancer diagnosis in the geriatric European population. The findings highlight the significant differences in survival between upper and lower GIT cancers, the gender-specific survival advantage in women with lower GIT cancers, the prognostic importance of HGS, and the adverse impact of increasing age at diagnosis. These results warrant the need for a comprehensive and personalized approach to the management of patients with GIT cancers, with a focus on addressing individual risk factors and tailoring treatment strategies to optimize outcomes. Declarations Ethics approval and consent to participate The experimental protocols for this study were approved by the ethics board of the Max-Planck-Society (Germany), with supporting documentation available on the SHARE website (FAQ Sect. 3.11, https://share-eric.eu/data/faqs-support). Consent for publication Not applicable. Clinical trial number Not applicable. Availability of data and material The data is publicly available after application from https://share-eric.eu/. Access to data requires an individual's free registration, followed by the acceptance of the SHARE Conditions and signing the SHARE User Statement. After acceptance of these documents, data can be downloaded using the personal ID and password. Competing interests SYG is a Senior Editorial Board Member of BMC Medical Education. Otherwise, no competing interests declared. Funding This work was supported by competitive grant (24010901166) from the University of Sharjah UAE to RQ. Qaisar. Authors’ contributions Conceptualization; S.G, R.Q, and M.H. Data curation; S.G, R.Q, & M.H. Formal analysis; S.G, R.Q, & M.H. Funding acquisition; R.Q.. Investigation; S.G, R.Q, & M.H. Methodology; S.G, R.Q, & M.H. Project administration; S.G, R.Q, & M.H. Resources; S.G, R.Q, & M.H. Supervision; S.G, R.Q, & M.H. Validation; S.G, R.Q, & M.H. Writing – original draft; S.G, R.Q, & M.H. Writing – review and editing; S.G, R.Q, & M.H. Acknowledgments This paper uses data from SHARE Waves 5, 6, 7, and 8 (DOIs: 10.6103/SHARE.w5.800, 10.6103/SHARE.w6.800, 10.6103/SHARE.w7.800, 10.6103/SHARE.w8.800). The SHARE data collection has been funded by the European Commission, DG RTD through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812), FP7 (SHARE-PREP: GA N°211909, SHARE-LEAP: GA N°227822, SHARE M4: GA N°261982, DASISH: GA N°283646) and Horizon 2020 (SHARE-DEV3: GA N°676536, SHARE-COHESION: GA N°870628, SERISS: GA N°654221, SSHOC: GA N°823782, SHARE-COVID19: GA N°101015924) and by DG Employment, Social Affairs & Inclusion through VS 2015/0195, VS 2016/0135, VS 2018/0285, VS 2019/0332, and VS 2020/0313. Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the U.S. National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C, RAG052527A), and from various national funding sources is gratefully acknowledged (see www.share-project.org). 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Salman Yousuf Guraya is senior editorila board member at BMC Medical Education Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 12 May, 2026 Reviews received at journal 09 May, 2026 Reviewers agreed at journal 29 Apr, 2026 Reviews received at journal 24 Apr, 2026 Reviewers agreed at journal 22 Apr, 2026 Reviews received at journal 06 Feb, 2026 Reviews received at journal 17 Nov, 2025 Reviewers agreed at journal 11 Nov, 2025 Reviewers agreed at journal 10 Nov, 2025 Reviewers invited by journal 09 Nov, 2025 Editor invited by journal 14 Oct, 2025 Editor assigned by journal 14 Oct, 2025 Submission checks completed at journal 14 Oct, 2025 First submitted to journal 12 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7839736","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":546938730,"identity":"36297732-141b-4674-b9d2-b24a40be2569","order_by":0,"name":"Salman Yousuf Guraya","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+0lEQVRIiWNgGAWjYFAC5gYE+wMQs7ET1MKI0MI4A6SFmRQtzDxgkoAG+faDrRt+7qhN3N5+xvCzza9t8nzMDIwfPubg1mJwJrHtZu+Z44lzzuQYS+f23TZsY2Zglpy5DY8WhsS2G7xtxxJnMOQYSOf23GYEamFj5sWjRb7/YdvNvyAt/G+Mf1v23LYnqIXhRmLbbd62msQZEjlm0gw/bicS1GJw42Hbbdm2A8YzJJ6VWfY23E5uY2ZsxusX+f7kYzffttXJzuBP3nzjx5/btvPbmw9++IjPYRBwGIg5DBgY20AcpJjCA+qAmP0BA8MfYhSPglEwCkbBSAMAjdNXrCpcAJsAAAAASUVORK5CYII=","orcid":"","institution":"University of Sharjah","correspondingAuthor":true,"prefix":"","firstName":"Salman","middleName":"Yousuf","lastName":"Guraya","suffix":""},{"id":546938731,"identity":"4fc03fd2-6a9f-4672-ace4-db79aa86c2b4","order_by":1,"name":"Rizwan Qaisar","email":"","orcid":"","institution":"University of Sharjah","correspondingAuthor":false,"prefix":"","firstName":"Rizwan","middleName":"","lastName":"Qaisar","suffix":""},{"id":546938732,"identity":"bc91d544-e15c-49e4-8960-cab2ff87ada5","order_by":2,"name":"M. Azhar Hussain","email":"","orcid":"","institution":"University of Sharjah","correspondingAuthor":false,"prefix":"","firstName":"M.","middleName":"Azhar","lastName":"Hussain","suffix":""}],"badges":[],"createdAt":"2025-10-12 09:38:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7839736/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7839736/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":96364418,"identity":"7e14e3a1-5c36-49cc-9e16-32fe19a51c41","added_by":"auto","created_at":"2025-11-20 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10:09:37","extension":"html","order_by":12,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":97252,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7839736/v1/3da59e91e3812384a15d17cd.html"},{"id":96364601,"identity":"693784b0-8339-42e2-a251-34ca4ae24dff","added_by":"auto","created_at":"2025-11-20 10:09:27","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":257925,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe Kaplan-Meier survival estimates by cancer type.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7839736/v1/db9584ec396f10f01a0d10a6.jpeg"},{"id":96285195,"identity":"6d65ead9-d846-40c1-a4ec-6040078bc72c","added_by":"auto","created_at":"2025-11-19 11:56:32","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":354659,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSurvival duration by cancer type (a) without and with (b) controls.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7839736/v1/b99b5287fa5b027e3b3d38f0.jpeg"},{"id":96285198,"identity":"595e341d-a06d-4b7f-bc19-d0b694a49603","added_by":"auto","created_at":"2025-11-19 11:56:32","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":502717,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eLife expectancy after different cancer diagnoses by gender and age.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7839736/v1/b3299e9149ac88b79d4ce6da.jpeg"},{"id":96365058,"identity":"9ab9a234-a747-49f5-980e-250865915081","added_by":"auto","created_at":"2025-11-20 10:09:57","extension":"jpeg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":516779,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eLife expectancy by handgrip strength as analysed separately for cancer types and gender.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7839736/v1/8acc6fb3cf96be4c5279a250.jpeg"},{"id":96369100,"identity":"5bff6d43-2216-47b8-b8ab-e6e6cdbbc89e","added_by":"auto","created_at":"2025-11-20 10:19:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2376590,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7839736/v1/1b0db253-b5a0-4b5e-bcbc-bb3b26394b9c.pdf"}],"financialInterests":"Competing interest reported. Salman Yousuf Guraya is senior editorila board member at BMC Medical Education","formattedTitle":"A tale of two tracts: Comparison of the survival rates of upper and lower GIT cancers by age, gender, and handgrip strength in geriatric population from 12 European countries","fulltext":[{"header":"Background","content":"\u003cp\u003eGastrointestinal tract (GIT) cancers have a high incidence rate and mortality, accounting for 5.1\u0026nbsp;million new cases and 3.6\u0026nbsp;million new deaths in 2020 worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. These cancers may primarily be classified as cancers of the upper (oral cavity, pharynx, esophagus, stomach, liver, and pancreas) and lower (colorectal) cancers. Both cancers have unique epidemiology, risk factors, and clinical outcomes. Such variation is evident by different 5-year survival rates; 65% for colorectal cancers and 33%, 21%, and 12% for gastric, esophageal, and pancreatic cancers, respectively [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. According to the available evidence in medicine, the treatment efficacy of GIT cancers is primarily determined by survival rates and cancer-related signs and symptoms, while overlooking the physical capacity of the patients. The physical capacity of patients with GIT cancers is a significant determinant of their prognosis and survival and, to some extent, signifies the outcomes of management plans [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMost GIT cancers, their surgical therapies, and chemotherapies cause significant myotoxicity with adverse effects on the physical independence of the patients [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Specifically, these patients face difficulty in performing physical activities, such as toileting, walking, dressing, and rising from a chair. The impairment of such activities is established as an independent risk factor for recurrence and mortality of patients with lower GIT cancers [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Therefore, it may be imperative to monitor the physical independence and activities of daily living in GIT cancer patients as markers of disease progression. However, the relevant data is often self-reported and have considerable subjective variability.\u003c/p\u003e\u003cp\u003eThe handgrip strength (HGS) objectively measures the quality of skeletal muscle in cancer patients [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. HGS is adversely affected by chemotherapy in GIT cancers and can be a reliable tool to predict postoperative complications [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] and survival [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] in GIT cancer. Thus, for GIT cancers, a combination of HGS with the activities of daily living may provide a comprehensive assessment of physical capacity of the affected patients. In GIT cancers, it may be critical to integrate physical capacity with the clinical efficacy of various therapies to obtain a broader perspective on the disease progression. However, several covariates, such as assessment settings (domestic versus clinical), demography and age of patients, racial and ethnic profiles, and socioeconomic status, may each influence the physical capacity of such cohort of patients. However, most relevant studies are performed in the context of regional settings and may not provide a representative dataset. The evaluation of a large dataset of patients with statistical adjustment for covariates may provide more relevant results for physical capacity.\u003c/p\u003e\u003cp\u003eIn our study, we used the dataset from the standardized Survey of Health, Ageing, and Retirement in Europe (SHARE), which contains a repository of the longitudinally conducted panel of geriatric adults aged 50 or above across multiple European countries [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. We compared and analysed age and gender specific data of patients with upper and lower GIT cancers for difficulties performing various routine physical activities, HGS, and survival rates after diagnosis. We hypothesized that the patients with upper GIT cancers exhibit more significant difficulties in performing activities of daily living, and reduced HGS than those with upper GIT cancers.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eThe study includes the geriatric population from the SHARE survey, a representative multi-disciplinary panel data study of individuals aged at least 50 years [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. SHARE is an international collaborative effort involving nearly all European countries that collects comprehensive data through in-person interviews. The individual-level information covers important dimensions of respondents\u0026rsquo; life-stories, including demographic characteristics, socioeconomic conditions, living arrangements, and aspects of the public and personal health situation. The baseline data for this study were obtained from the fifth wave of SHARE conducted in 2013. Still, information from wave 4 (interviews during 2010\u0026ndash;2012) was also included: only people without cancer in wave 4 and diagnosed with cancer in wave 5 were included. Subsequent waves, namely wave 6 (2015), wave 7 (2017), wave 8 (2019/2020), and wave 9 (2021/2022), served as follow-up surveys, allowing for the examination of changes over time.\u003c/p\u003e\u003cp\u003eSHARE study wave 5 collected information on cancer in the questionnaire, after showing the respondent a list of 20 diseases/2 other options, where cancer was identified through the question: \u0026ldquo;Has a doctor ever told you that you had/Do you currently have any of the conditions on this card? With this we mean that a doctor has told you that you have this condition, and that you are either currently being treated for or bothered by this condition Please tell me the number or numbers of the conditions\u0026rdquo;. Among the possible answers were: \u0026ldquo;Cancer or malignant tumor, including leukemia or lymphoma, but excluding minor skin cancers\u0026rdquo;. If cancer was chosen the respondent was asked: \u0026ldquo;In which organ or part of the body have you or have you had cancer?\u0026rdquo;. Possible answers included 22 specific organs and the category \u0026ldquo;other organ\u0026rdquo;. Upper GIT cancer is present when the respondent chooses the following six organs: Oral cavity, other pharynx, esophagus, stomach, liver, or pancreas. Lower GIT cancer is present when the respondent said the organ was: the colon or the rectum. Subjects were followed in subsequent waves 6, 7, 8, and 9, and it was identified when the person was no longer in the survey due to death. It was thus possible to estimate for how long subjects survived after being diagnosed with a specific type of the two mentioned cancers for those who died during waves 6\u0026ndash;9. The rest are right-censored, i.e., they were still alive in wave 9 but will eventually pass away. This censoring means that traditional regression methodologies cannot be applied, and we estimate the survival of patients using duration analysis.\u003c/p\u003e\u003cp\u003eHGS was measured using a hand-held dynamometer (Smedley, S Dynamometer, TTM, Tokyo, 100 kg) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Patients with swelling or inflammation, severe pain or recent injury, or a recent surgery to the hand were excluded from the study. Participants were instructed to press the dynamometer with their left and right hands, performing two repetitions with each hand. If a participant could not use with one hand, measurements were only taken from the other hand. The test instructions required the participants to maintain an upright posture with their upper arm parallel to their torso and their lower arm perpendicular to their torso. If necessary, the test could also be performed in a sitting position. The highest recorded value from these four measurements was used in the subsequent analysis. Low HGS was defined based on gender-specific thresholds, following the guidelines by the European Working Group on Sarcopenia in Older People (EWGSOP2), with thresholds of 27 KG for males and 16 KG for females [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical analysis\u003c/h2\u003e\u003cp\u003eMultiple regression analyses were applied to identify individual characteristics affecting survival after a specific cancer diagnosis. Time t (years) to death was statistically modelled as\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:\\text{ln}t={\\beta\\:}_{0}+{\\beta\\:}_{1}Female+AgeGroups{\\beta\\:}_{2}+HGSGroups{\\beta\\:}_{3}+z$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003ewhere: Female\u0026thinsp;=\u0026thinsp;1 if the respondent was a female (and 0 for base category males); age group dummies are 60\u0026ndash;69 years, 70\u0026ndash;79 years, and 80\u0026thinsp;+\u0026thinsp;years (50\u0026ndash;59 years is the base category); HGS groups are low HGS and missing HGS (high HGS is the base category). Coefficients (vectors) β1, β2, and β3 represent effect on survival for the three individual characteristics. The \u003cem\u003ez\u003c/em\u003e term is the error following the f(.) distribution with an extreme-value density yielding the Weibull regression model (and exponential model). The hazard (empirically, probability of death at time \u003cem\u003et\u003c/em\u003e, given survival till time \u003cem\u003et\u003c/em\u003e) \u003cem\u003eh\u003c/em\u003e and survival (empirically, the probability of survival at time \u003cem\u003et\u003c/em\u003e) \u003cem\u003eS\u003c/em\u003e functions are\u003cdiv id=\"Equb\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equb\" name=\"EquationSource\"\u003e\n$$\\:h\\left(t\\right)=p{\\bullet\\:\\lambda\\:\\bullet\\:t}^{p-1}\\:\\text{a}\\text{n}\\text{d}\\:S\\left(t\\right)={e}^{-\\lambda\\:\\bullet\\:{t}^{p}}\\:,\\:\\lambda\\:={e}^{-p\\bullet\\:\\varvec{x}\\varvec{\\beta\\:}}$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003ewhere the shape parameter \u003cem\u003ep\u003c/em\u003e is estimated from the data (σ\u0026thinsp;=\u0026thinsp;1/\u003cem\u003ep\u003c/em\u003e). All statistical analyses were performed with the software package STATA 18.0 SE Standard Edition (Release 18. College Station, TX: StataCorp LLC) using the Stata commands stset, sts graph, streg, margins, and marginsplot.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eDemographic characteristics of participants\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e presents summary statistics for individuals categorized into three groups: those with no cancer, those with upper GIT cancer, and those with lower GIT cancer. This table includes data on gender, age, handgrip strength from wave 5, and survival at the last recorded waves 6-9. Regarding gender distribution, among individuals without cancer, 43.0% were men and 57.0% were women. In contrast, among those with upper GIT cancer, 53.8% were men and 46.2% were women, while for lower GIT cancer, there were 59.6% men and 40.4% women. \u0026nbsp;Regarding age distribution, most individuals were in the 60-69 age group across all cancer categories.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe HGS data analysis showed that most individuals had high strength, but a higher percentage of GIT cancer patients had low strength than those without cancer. Some HGS data were missing, particularly in the lower GIT cancer group. Survival status showed that a more significant proportion of GIT cancer patients passed away compared to those without cancer. The percentage of deceased individuals was highest in the lower GIT cancer group (65.7%), followed by the upper GIT cancer group (60.4%).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"708\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eNo cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eUpper GIT cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eLower GIT cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eAll\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e14,338\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e43.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e53.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e59.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e14,454\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e43.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e18,836\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e56.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e46.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e40.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e18,925\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e56.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e50-59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e10,436\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e31.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e23.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e10,473\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e31.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e60-69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e11,512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e34.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e34.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e34.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e11,582\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e34.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e70-79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e7,998\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e24.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e36.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e31.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e8,068\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e24.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e80+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e3,228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e9.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e16.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e3,256\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e9.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eHandgrip strength\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2,117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e12.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2,135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e28,773\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e86.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e80.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e85.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e28,943\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e86.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2,284\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e9.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e2,301\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e6.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eSurvival at last wave\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003ePassed away\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e16,438\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e49.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e60.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e65.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e16,567\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e49.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eAlive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e16,736\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e50.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e39.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e34.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e16,812\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e50.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e33,174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e33,379\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"9\" valign=\"bottom\"\u003e\n \u003cp\u003eSource: Own calculations based on SHARE-ERIC datasets from waves 4-9.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e. \u003cstrong\u003eSummary statistics of the study population.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eKaplan-Meier survival results\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn \u003cstrong\u003eFigure 1\u003c/strong\u003e, the Kaplan-Meier survival curve illustrates the survival probabilities over nine years for individuals with no cancer, lower GIT, and upper GIT cancer. The y-axis represents survival probability from 1.0 (100%) to 0.0 (0%), while the x-axis shows years of survival. All groups start at a survival probability 1.0, meaning 100% of individuals were alive initially. However, survival probabilities declined over time, with apparent differences between groups. By year 3, about 80% of individuals without cancer remained alive, while survival for lower GIT cancer was approximately 70%, and upper GIT cancer survival dropped below 60%. By year 6, survival for upper GIT cancer dropped to almost 40%, while lower GIT cancer remained slightly higher at about 50%. Lastly, by year 9, survival for the no-cancer group remained above 50%, while the lower and upper GIT cancer groups dropped below 40%.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRegression of survival time\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e outlines the results of survival regression analysis using the Weibull distribution, focusing on how cancer type, gender, age, and HGS affected survival outcomes across various subgroups. The coefficients represent the relationship between each factor and the risk of the event, with significance levels indicated by asterisks. The analysis showed that upper GIT cancer was associated with an increased risk in the overall population. In column one, the coefficient for upper GIT cancer is 0.334**, which indicates a statistically significantly higher risk of death for individuals with upper GIT cancer. In column one for lower GIT cancer, the coefficient is 0.578***, statistically significant at the 1% level. Regarding gender, women were generally associated with a lower risk of death. In column one, the coefficient for women was -0.218***, indicating a significant protective effect compared to men. This negative association was more pronounced in other subgroups, such as column 6 (HGS included continuously), where the coefficient was -2.039***, showing a substantial reduction in risk for women.\u0026nbsp;\u003c/p\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"764\" class=\"fr-table-selection-hover\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003eAll\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003eAll\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003eNo cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003eUpper GIT cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003eLower GIT cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003eAll\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003eLower GIT cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e(1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e(2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e(3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e(4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e(5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e(6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e(7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003eCancer type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003eUpper GIT cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.335**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.133\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.0976\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003eLower GIT cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.579***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.594***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.644***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e-0.215***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.214***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e-0.0608\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e-0.480\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e-0.544***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e-0.979*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e60-69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e-0.00671\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e-0.0745***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.858*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e70-79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.422***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.425***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.424\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.458\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.286***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.661\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e80+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1.105***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.108***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.883*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e1.688***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.916***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e1.602**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003eHandgrip strength\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003eHigh\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e-0.365***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.365***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e-0.770\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.525\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003eMissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.0744*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.0765*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003eContinous\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e-0.0206***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e-0.0426*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003eln p\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e0.173***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.216***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.218***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.0787\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.222***\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e0.140\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 120px;\"\u003e\n \u003cp\u003eSample size\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e33379\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003e33379\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\n \u003cp\u003e33174\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e31078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" valign=\"bottom\" style=\"width: 454px;\"\u003e\n \u003cp\u003eNote: Left out categories are no cancer, male, 50-59 years, and low HGS.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 235px;\"\u003e\n \u003cp\u003e* p\u0026lt;0.05, ** p\u0026lt;0.01, *** p\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 235px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 73px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 70px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 76px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 77px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eSurvival regression analysis for groups with upper and lower GIT cancers and no cancers applying the Weibull distribution.\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor individuals aged 60-69, the reported coefficient was -0.0596**, suggesting a slight reduction in mortality risk, while those aged 70-79 had a positive coefficient of 0.233***, indicating a higher risk. The coefficient for individuals aged 80 and above was 0.895***, emphasizing an increased risk for older individuals. HGS was associated with a reduced risk. In the All group category, participants with high HGS had a coefficient of -0.416***, suggesting that better physical strength is protective for better survival.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eExpected survival time\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eBased on the regression analysis results, we can estimate the expected survival of individuals with different demographics and clinical conditions. \u003cstrong\u003eFigure 2\u003c/strong\u003e illustrates the significance of including controls when estimating survival rates in the case of lower GIT cancer. The expected number of survived years differs by more than a year among patients with upper and lower GIT cancers and those without cancers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 3\u003c/strong\u003e presents life expectancy after diagnosing different cancers as classified by gender and age in our study. Individuals without cancers had the highest survival, especially among those aged 50-69 years, while older age groups showed a decline in survival rates. Women tend to live slightly longer than men. Upper GIT cancer significantly reduces life expectancy, with younger patients (50-69 years) having better survival than older individuals. Lower GIT cancer showed slightly better survival than upper GIT cancer, though still lower than those without cancer. Age was found to be a critical factor, as survival declined remarkably in individuals over 80 years.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThere were gender differences with overlapping confidence intervals, but not substantial. Figure 3 highlights the impact of cancer type on survival. Not surprisingly, individuals without cancers maintained the longest life expectancy across all age groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 4\u003c/strong\u003e illustrates the relationship between HGS and life expectancy, analyzed separately by cancer type and gender. The horizontal axis represents HGS, while the vertical axis shows expected years of survival. In panel a, which focuses on cancer type, individuals without cancer had the highest life expectancy across all levels of HGS. Those with upper GIT cancer had lower survival than the no-cancer group, but higher than participants with lower GIT cancer. Across all groups, stronger HGS was associated with more prolonged survival, highlighting the importance of muscle strength as a predictor of longevity. Panel b focuses on gender differences in survival for upper GIT cancer patients. Women consistently had higher survival rates than men at all HGS levels. The survival gap widened as HGS increases, suggesting that muscle strength is more significant in extending life expectancy for women than men.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn our study, the large representative dataset from SHARE highlights several significant findings about survival in patients with upper and lower GIT cancers. We found that the participants diagnosed with lower GIT cancers experienced lower survival than those with upper GIT cancers. Furthermore, our study reported comparable years of survival for both genders following the diagnosis of upper GIT cancer. Women demonstrated significantly longer survival than men following the diagnosis of lower GIT cancer. The HGS at the time of diagnosis of GIT cancers was found to be a critical influencer, with lower HGS predicting shorter survival. Finally, consistent with previous research, increasing age at the time of diagnosis was significantly associated with reduced years of survival.\u003c/p\u003e\u003cp\u003eThe reduced survival of patients with lower GIT cancers compared to those with upper GIT cancers is consistent with previous reports [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Thus, the general trend suggests that the anatomical location of the primary tumor significantly influences prognosis. Several factors could contribute to this disparity. Lower GIT cancers often present itself with different patterns of metastasis and may involve distinct molecular subtypes that exhibit varying degrees of aggressiveness [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Moreover, the proximity of lower GIT tumors to critical structures and the potential for complex surgical interventions could also play a role in survival outcomes [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. However, it is important to acknowledge that the SHARE data does not provide details about the extent of cancer spread and the quality of therapeutic interventions.\u003c/p\u003e\u003cp\u003eThe observed gender differences in survival rates following the diagnosis of lower GIT cancer, with women exhibiting a more favorable outcome, is a critical observation in our study. While survival in upper GIT cancers appears to be more similar across genders, the divergence in lower GIT cancers suggests a potential interplay of biological and social factors. Biological factors, such as, variations in tumor biology, have been proposed as potential contributors [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Additionally, social factors, including differences in healthcare-seeking behavior, treatment adherence, and social support networks, may also play a role. Social drivers of health influence each stage of the cancer care continuum, and racial and ethnic minority patients experience higher rates of adverse social effects such as housing insecurity, few educational opportunities, and low socioeconomic status [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The SHARE dataset, while valuable, may not fully capture the complexity of these interactions.\u003c/p\u003e\u003cp\u003eAnother key finding of our study was that low HGS at the time of GIT cancer diagnosis predicted shorter survival irrespective of the location of the GIT cancer. HGS is a well-established marker of overall muscle strength and functional capacity, and it has been increasingly recognized as a prognostic indicator in various health conditions, including cancer [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Sarcopenia, the loss of muscle mass and strength, is common in older adults, particularly among those with chronic malignancies [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Reduced HGS is a key indicator of sarcopenia and can reflect a decline in physiological reserve, making individuals more vulnerable to the adverse effects of cancer and its treatment. Our findings are consistent with studies that have shown the presence of other chronic age-related diseases a predictors for poor physical capacity of the affected patients [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Several mechanisms can explain the prognostic values of HGS in our study cohort. A low HGS is frequently associated with sarcopenia and frailty in old age [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Sarcopenia can likely lead to increased frailty, reduced tolerance to chemotherapy and surgery, and a higher risk of complications. Furthermore, it may be associated with increased inflammation and metabolic dysfunction, which can promote tumor growth and progression.\u003c/p\u003e\u003cp\u003eTherefore, our study and the available corpus of literature proposes that the assessment of HGS in older adults diagnosed with GIT cancer can be used as a valuable prognostic indicator that can help clinical decision-making. Additionally, interventions to improve muscle strength and physical function such as exercise programs and nutritional support, may improve survival [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Further, it is essential to consider that GIT cancers can affect nutritional status and metabolic processes differently. Upper GIT cancers may lead to earlier and more severe malnutrition due to difficulties with swallowing and digestion. Conversely, lower GIT cancers may negatively affect nutrient absorption and bowel function. These functional differences caused by structural variations among GIT cancers lead to sarcopenia and low HGS, influencing overall cancer survival. Therefore, it is proposed that exercise therapies and nutritional support in cancer patients may adequately address sarcopenia, improve the response to cancer therapies, and improve the overall survival after diagnosis [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eFinally, the finding of our study that increasing age at the time of GIT cancer diagnosis is associated with reduced years of survival corroborates a substantial body of evidence [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Age is a well-established risk factor for cancer development, and older individuals often present with more advanced disease and a greater burden of comorbidities. Older patients may also be less tolerant of aggressive cancer treatments, and their overall physiological reserve may be limited. These factors contribute to poorer outcomes in older cancer patients. Our results highlight the importance of considering age as a critical prognostic factor in managing elderly individuals with GIT cancer [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Therefore, it is crucial to tailor treatment strategies to the specific needs of elderly patients, considering their overall health status, functional capacity, and treatment preferences. Comprehensive geriatric assessments can help identify older patients at higher risk of adverse outcomes and guide the development of individualized treatment plans.\u003c/p\u003e\n\u003ch3\u003eStudy limitations\u003c/h3\u003e\n\u003cp\u003eThis study has several limitations. First, the data were derived from self-reported survey responses, which may introduce recall bias or reporting inaccuracies. Second, the SHARE dataset lacks detailed clinical information such as cancer staging, histological subtypes, treatment modalities, and comorbidities, which could affect survival outcomes. Lastly, despite adjustments for key covariates, residual confounding but unmeasured factors such as nutritional status or functional capacity beyond HGS cannot be overlooked.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study, using data from SHARE, provides valuable insights into the factors influencing survival following GIT cancer diagnosis in the geriatric European population. The findings highlight the significant differences in survival between upper and lower GIT cancers, the gender-specific survival advantage in women with lower GIT cancers, the prognostic importance of HGS, and the adverse impact of increasing age at diagnosis. These results warrant the need for a comprehensive and personalized approach to the management of patients with GIT cancers, with a focus on addressing individual risk factors and tailoring treatment strategies to optimize outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe experimental protocols for this study were approved by the ethics board of the Max-Planck-Society (Germany), with supporting documentation available on the SHARE website (FAQ Sect. 3.11, https://share-eric.eu/data/faqs-support).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eClinical trial number\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and material\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe data is publicly available after application from\u0026nbsp;https://share-eric.eu/. Access to data requires an individual\u0026apos;s free registration, followed by the acceptance of the SHARE Conditions and signing the SHARE User Statement. After acceptance of these documents, data can be downloaded using the personal ID and password.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interests\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eSYG is a Senior Editorial Board Member of BMC Medical Education. Otherwise, no competing interests declared.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by competitive grant (24010901166) from the University of Sharjah UAE to RQ. Qaisar.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cem\u003eAuthors\u0026rsquo; contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization; S.G, R.Q, and M.H. Data curation; S.G, R.Q, \u0026amp; M.H. Formal analysis; S.G, R.Q, \u0026amp; M.H. Funding acquisition; R.Q.. Investigation; S.G, R.Q, \u0026amp; M.H. Methodology; S.G, R.Q, \u0026amp; M.H. Project administration; S.G, R.Q, \u0026amp; M.H. Resources; S.G, R.Q, \u0026amp; M.H. Supervision; S.G, R.Q, \u0026amp; M.H. Validation; S.G, R.Q, \u0026amp; M.H. Writing \u0026ndash; original draft; S.G, R.Q, \u0026amp; M.H. Writing \u0026ndash; review and editing; S.G, R.Q, \u0026amp; M.H.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgments\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThis paper uses data from SHARE Waves 5, 6, 7, and 8 (DOIs: 10.6103/SHARE.w5.800, 10.6103/SHARE.w6.800, 10.6103/SHARE.w7.800, 10.6103/SHARE.w8.800). The SHARE data collection has been funded by the European Commission, DG RTD through FP5 (QLK6-CT-2001-00360), FP6 (SHARE-I3: RII-CT-2006-062193, COMPARE: CIT5-CT-2005-028857, SHARELIFE: CIT4-CT-2006-028812), FP7 (SHARE-PREP: GA N\u0026deg;211909, SHARE-LEAP: GA N\u0026deg;227822, SHARE M4: GA N\u0026deg;261982, DASISH: GA N\u0026deg;283646) and Horizon 2020 (SHARE-DEV3: GA N\u0026deg;676536, SHARE-COHESION: GA N\u0026deg;870628, SERISS: GA N\u0026deg;654221, SSHOC: GA N\u0026deg;823782, SHARE-COVID19: GA N\u0026deg;101015924) and by DG Employment, Social Affairs \u0026amp; Inclusion through VS 2015/0195, VS 2016/0135, VS 2018/0285, VS 2019/0332, and VS 2020/0313. Additional funding from the German Ministry of Education and Research, the Max Planck Society for the Advancement of Science, the U.S. National Institute on Aging (U01_AG09740-13S2, P01_AG005842, P01_AG08291, P30_AG12815, R21_AG025169, Y1-AG-4553-01, IAG_BSR06-11, OGHA_04-064, HHSN271201300071C, RAG052527A), and from various national funding sources is gratefully acknowledged (see www.share-project.org).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBray F, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang X, et al. Global status of research on gastrointestinal cancer patients' quality of life: A bibliometric and visual analysis from 2003 to 2023. Heliyon. 2024;10(1):e23377.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePolat K, et al. The Relationship between Exercise Capacity and Muscle Strength, Physical Activity, Fatigue and Quality of Life in Patients with Cancer Cachexia. Nutr Cancer. 2024;76(1):55\u0026ndash;62.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAmemiya T, et al. Activities of daily living and quality of life of elderly patients after elective surgery for gastric and colorectal cancers. Ann Surg. 2007;246(2):222\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMima K, et al. Impairment of Activities of Daily Living is an Independent Risk Factor for Recurrence and Mortality Following Curative Resection of Stage I-III Colorectal Cancer. J Gastrointest Surg. 2021;25(10):2628\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHadzibegovic S, et al. Hand grip strength in patients with advanced cancer: A prospective study. 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Cancer. 2013;119(4):739\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Gastrointestinal cancer, handgrip strength, physical capacity, SHARE, survival","lastPublishedDoi":"10.21203/rs.3.rs-7839736/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7839736/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eGastrointestinal tract (GIT) cancers are among the most prevalent malignancies worldwide. Due to variations in anatomical locations and biological behaviors of upper and lower GIT cancers, differences exist in their survival and physical capacity domains. Limited large-scale comparative datasets exist for upper and lower GIT cancers, particularly in the geriatric population. This study aimed to compare survival rates and handgrip strength (HGS) between upper and lower GIT cancer European geriatric patients, with specific attention to age and gender differences.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eThis longitudinal cohort study used data about the European geriatric population from the Survey of Health, Ageing, and Retirement in Europe (SHARE) across waves 4 to 9. HGS was measured using a dynamometer. Regression analysis was performed using the survival methodology with a Weibull distribution adjusted for age, gender, and HGS.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 33,379 adults aged\u0026thinsp;\u0026ge;\u0026thinsp;50 were included, comprising 106 participants with upper GIT cancer and 99 with lower GIT cancer. Overall, nine-year survival was 39.6% for upper GIT and 34.3% for lower GIT cancer patients. Lower GIT cancer was associated with significantly higher mortality risk (β\u0026thinsp;=\u0026thinsp;0.579, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Female gender conferred a protective effect (β = -0.215, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with women showing notably better survival than men in the lower GIT group. Advanced age (\u0026ge;\u0026thinsp;80 years) significantly increased mortality risk (β\u0026thinsp;=\u0026thinsp;1.105, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Higher HGS was associated with longer survival (β = -0.365, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), particularly in upper GIT cancers.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eIn this study, patients with lower GIT cancers had worse survival compared to upper GIT cancers, particularly among older men with low HGS. Women with lower GIT cancers had a survival advantage over men, while HGS had a stronger positive predictive value in upper GIT cancers. These distinctions call for personalized and targeted assessment and management plans for GIT cancers.\u003c/p\u003e","manuscriptTitle":"A tale of two tracts: Comparison of the survival rates of upper and lower GIT cancers by age, gender, and handgrip strength in geriatric population from 12 European countries","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-19 11:56:28","doi":"10.21203/rs.3.rs-7839736/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-12T04:55:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-09T10:34:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"152414877613156697945042223222775762117","date":"2026-04-30T00:44:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-24T13:01:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"293694710300732594721136035970361667793","date":"2026-04-22T10:48:18+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-06T18:55:54+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-18T03:29:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"181633633751281249589120407203360608341","date":"2025-11-12T04:24:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"267913309663906366516514074508545135559","date":"2025-11-10T20:22:28+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-10T04:23:10+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-14T06:49:36+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-14T05:41:49+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-14T05:41:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cancer","date":"2025-10-12T09:34:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cancer","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcan","sideBox":"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcan/default.aspx","title":"BMC Cancer","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e1eb2087-2338-4a58-a08b-c5fea09da117","owner":[],"postedDate":"November 19th, 2025","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-12T04:55:30+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-09T10:34:02+00:00","index":107,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-20T12:38:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-19 11:56:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7839736","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7839736","identity":"rs-7839736","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}