Risk Factors of Survival in Elderly Gastric Cancer Patients after Gastrectomy

Abstract Background There are few studies on risk factors of surgical mortality in elderly gastric cancer (GC) patients with curative gastrectomy. This study aimed to investigate the tumor-specific survival (TTS) and associated risk factors in this elderly GC patients and help to enhance perioperative care in high risk GC patients. Methods Elderly GC patients (≥70 years) who underwent gastrectomy between January 2013 and December 2017 in Peking Union Medical College Hospital were included. Clinicopathologic characteristics, nutritional assessment (Nutritional risk screening 2002, NRS2002, prognostic nutrition index, PNI), comorbidities (Charlson Comorbidity index, CCI)), operation and survival data by regular follow-up were collected. Receiver Operating Characteristic (ROC) analysis was used to extract the best cut-off point. Impact of factors on TSS was assessed using Cox proportional hazards model. Results Univariate analysis determined multiple variables as risk factors of TSS mainly including BMI (Hazard ration [HR]=0.886; 95%CI, 0.824-0.952; p=0.001), CCI ≥3 (HR=2.834; 95%CI, 1.258-3.711; p=0.005), ICU admission (HR=1.733; 95%CI, 1.077-2.788; p=0.024), NRS2002 score ≥5 (HR=2.331; 95%CI, 1.448-3.753; p=0.000), preoperative PNI <45 (HR=2.058; 95%CI, 1.273-3.327; p=0.003). Best cut-off BMI point was 20.65 kg/m 2 by ROC curve. Multivariate analysis showed that BMI ≤20.6 kg/m 2 (HR=2.297; 95%CI, 1.362-3.874; p=0.002), postoperative ICU admission (HR=1.965; 95%CI, 1.171-3.300; p=0.011) and TNM staging (Stage II, HR=5.560, 95%CI, 1.591-19.426, p=0.007; Stage III, HR=16.202, 95%CI, 4.991-52.591, p=0.000) were significantly associated with TSS. Conclusions Preoperative BMI <20.6 kg/m 2 , postoperative ICU admission and TNM stage are strong risk factors of TSS in elderly GC patients after gastrectomy. The need of comprehensive evaluation and nutrition support are urgent, particularly for the elderly GC patients.