Risk factors for cancer-specific survival in elderly gastric cancer patients after curative gastrectomy

A competing-risk nomogram for predicting gastric cancer-specific survival in patients over 70 years: A SEER-based study

BACKGROUND

Cancer-specific survival in older patients with gastric cancer is competitively affected by death from other causes. This study aimed to investigate cancer-specific survival and associated risk factors by competing-risk analysis in older patients with gastric cancer.

METHODS

The data of this study are from the SEER database, using univariable and multivariable analysis of competitive risk model to weaken the impact of competitive events, explore the risk factors of cancer-specific survival, and developed a nomogram model. Then, the performance of the model is verified by C-index, ROC curve, calibration curve and DCA, and the new model is compared with the traditional TNM stage by NRI and IDI.

RESULTS

Our study encompassed a total of 8183 patients, with 5731 in the training cohort and 2452 in the validation cohort. Univariable and multivariable analysis showed that age, years of diagnosis, race, site, SEER stage, TNM stage, surgery, radiation or chemotherapy, LNE, tumor grade and size are independent risk factors for cancer-specific survival in older patients with gastric cancer. Based on the risk factors, we developed a diagram model to predict cancer-specific survival. C-index, ROC curve, calibration curve and DCA also show good results. We compared the new model with the traditional TNM stage model, and the NRI and IDI showed the new model has been significantly improved.

CONCLUSION

This study developed a nomogram to predict the cancer-specific survival of older patients with gastric cancer, which can accurately predict the prognosis and contribute to clinical treatment decision-making.

Controlling Nutritional Status (CONUT) Score as Prognostic Indicator in Stage IV Gastric Cancer with Chronic Intestinal Failure

The management of chronic intestinal failure (CIF) secondary to advanced gastric cancer poses clinical challenges. This study explores the correlation between the Controlling Nutritional Status (CONUT) index and survival in patients with TNM stage IV gastric cancer on home parenteral nutrition (HPN).

METHODS

From 2015 to 2023, 410 patients (37% women, 63% men) with CIF due to advanced gastric cancer were assessed using CONUT scores, BMI, and biochemical tests. The Cox proportional hazards model was used to evaluate the impact of covariates on survival. Logistic regression categorized malnutrition levels by CONUT scores, with performance evaluated using precision, recall, and F1 scores. A p-value < 0.001 was statistically significant.

RESULTS

The CONUT scores were independent predictors of survival, with higher CONUT scores increasing mortality risk (HR = 2.073, 95% CI: 1.815-2.369, p < 0.001). The model achieved an overall accuracy of 71%, indicating correct classification for the majority of cases.

CONCLUSIONS

CONUT scores are key predictors of survival in patients receiving HPN for CIF due to stage IV gastric cancer.

Effect of Preoperative Body Mass Index on Postoperative and Long-Term Outcomes in an East Indian Gastric Cancer Cohort

BACKGROUND

Gastric cancer is a global health concern with varying clinical outcomes. This study aims to investigate the influence of preoperative Body Mass Index (BMI) on survival in patients who underwent curative resection for gastric cancer in Eastern India.

METHODS

Data from a prospectively maintained Surgical Oncology database were analysed for patients who underwent curative resection for primary gastric adenocarcinoma between May 2016 and March 2022. Patients with incomplete data were excluded. Preoperative BMI was categorised into three groups: Underweight (< 18.5 kg/m2), Normal (18.5-22.9 kg/m2), and Overweight/Obese (=23 kg/m2). Clinicopathological details, short-term outcomes, and long-term oncological outcomes were assessed. Statistical analysis included survival estimates, Cox proportional hazard models, and subgroup analysis.

RESULT

Of 162 patients, 145 met the inclusion criteria. Patients were predominantly male (68%) with middle or lower socioeconomic status. No significant differences amongst BMI groups were observed in performance score, tumour grade, clinical stage, or short-term outcomes. Postoperative complications and 30-day mortality were similar. However, underweight patients had poorer 4-year disease-free survival (DFS) compared to overweight/obese patients (14.3% vs. 39.7%, p = 0.03). Overweight/obese patients showed significantly better 4-year overall survival (OS) than underweight patients (47.8% vs. 20.4%, p = 0.03).

CONCLUSIONS

In Eastern Indian gastric cancer patients undergoing curative resection, preoperative higher BMI (overweight/obese) was associated with better long-term survival. Understanding these findings could guide tailored interventions to improve outcomes in this population.