Preoperative Frailty Assessed Comprehensively by a Questionnaire Predicts a Poor Survival Following Curative Resection of Gastric Cancer

Abstract Background: With the increasing number of elderly people in Japan, there are more and more opportunities for physicians to treat elderly patients. In general, elderly patients are considered to be at increased risk for treatment due to a decreased organ reserve. In recent years, the concept of frailty has been attracting attention as a comprehensive indicator of the various effects of aging, but no conclusion has been reached on how to evaluate it. The present study investigated the adverse effect of preoperative frailty on short- and long-term outcomes in patients with gastric cancer using a questionnaire about frailty. Methods: Of the 149 patients who underwent curative gastrectomy for gastric cancer in our department between April 2015 and December 2016 and had pathological stage (p Stage) I/II/III, 125 were enrolled in this study, excluding 24 patients who failed to respond to the preoperative questionnaire on frailty.The frailty index (FI) was calculated by dividing the total score of 50 questions, consisting of 1 point per question, by 50. The study used a multiple logistic regression analysis with the 5-year overall survival (OS) as the endpoint to create a receiver operating characteristic (ROC) curve to determine the cut-off point for the FI. Based on the results, patients were classified into frail and non-frail groups. The short- and long-term outcomes of the frail and non-frail groups were then compared, and prognostic factors for the OS were examined. Postoperative complications were defined as those of Clavien-Dindo grade ≥3a. Results: Regarding the short-term outcomes, the postoperative complication rates did not differ significantly between the frail and non-frail groups. Regarding the5-year OS rates of the patients with p Stages II/III, the outcomes in the frail group were significantly poorer than those in the non-frail group. In the multivariate analysis of the OS, frailty was independently associated with unfavorable outcomes in patients with gastric cancer. Conclusion: Frailty in the present study encompasses not only patients' physical factors but also their psychological and social factors, which may be useful for predicting the long-term prognosis of patients undergoing surgical treatment for advanced gastric cancer.