Clinical impact of evaluation of frailty in endoscopic submucosal dissection for early gastric cancer in elderly patients
Noboru Misawa
Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
Search for more papers by this authorTakuma Higurashi
Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
Search for more papers by this authorJun Tachikawa
Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
Search for more papers by this authorHiroaki Tanabe
Department of Gastroenterology, Chigasaki Municipal Hospital, Chigasaki, Japan
Search for more papers by this authorTsutomu Yoshihara
Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
Search for more papers by this authorKeiichi Ashikari
Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
Search for more papers by this authorKenji Kanoshima
Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
Search for more papers by this authorAkiko Fuyuki
Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
Search for more papers by this authorHidenori Ohkubo
Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
Search for more papers by this authorYusuke Saigusa
Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
Search for more papers by this authorHideyuki Chiba
Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
Search for more papers by this authorTakashi Nonaka
Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
Department of Gastroenterology, National Hospital Organization Yokohama Medical Center, Yokohama, Japan
Search for more papers by this authorHitoshi Kuriyama
Department of Gastroenterology, Chigasaki Municipal Hospital, Chigasaki, Japan
Search for more papers by this authorNoritoshi Kobayashi
Department of Oncology Division, Yokohama City University School of Medicine, Yokohama, Japan
Search for more papers by this authorCorresponding Author
Atsushi Nakajima
Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
Correspondence
Professor Atsushi Nakajima MD, PhD, Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
Email: [email protected]
Search for more papers by this authorNoboru Misawa
Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
Search for more papers by this authorTakuma Higurashi
Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
Search for more papers by this authorJun Tachikawa
Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
Search for more papers by this authorHiroaki Tanabe
Department of Gastroenterology, Chigasaki Municipal Hospital, Chigasaki, Japan
Search for more papers by this authorTsutomu Yoshihara
Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
Search for more papers by this authorKeiichi Ashikari
Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
Search for more papers by this authorKenji Kanoshima
Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
Search for more papers by this authorAkiko Fuyuki
Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
Search for more papers by this authorHidenori Ohkubo
Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
Search for more papers by this authorYusuke Saigusa
Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
Search for more papers by this authorHideyuki Chiba
Department of Gastroenterology, Omori Red Cross Hospital, Tokyo, Japan
Search for more papers by this authorTakashi Nonaka
Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
Department of Gastroenterology, National Hospital Organization Yokohama Medical Center, Yokohama, Japan
Search for more papers by this authorHitoshi Kuriyama
Department of Gastroenterology, Chigasaki Municipal Hospital, Chigasaki, Japan
Search for more papers by this authorNoritoshi Kobayashi
Department of Oncology Division, Yokohama City University School of Medicine, Yokohama, Japan
Search for more papers by this authorCorresponding Author
Atsushi Nakajima
Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan
Correspondence
Professor Atsushi Nakajima MD, PhD, Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
Email: [email protected]
Search for more papers by this authorAbstract
Aims
Endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) is performed safely and effectively in elderly patients; however, whether ESD for EGC in elderly patients with frailty is safe and improves prognosis remains unclear.
Methods
In total, 142 patients aged ≥80 years who underwent ESD for EGC between September 2008 and September 2014 were included. We compared outcomes between patients with frailty and those without frailty. Frailty was assessed using the Clinical Frailty Scale (CFS) based on a patient's status before admission. Study endpoints were short- and long-term clinical outcomes after ESD.
Results
Patients were allocated into two groups: no frailty (CFS 1–3, n = 101) versus frailty (CFS 4–7, n = 41). Short-term clinical outcomes, specifically, adverse events and curability, did not differ between the two groups. For the long-term clinical outcomes, patients with frailty had significantly worse outcomes after ESD than those without frailty (the 3-year overall survival rates were 73.2% vs. 93.1%; P < 0.001 with log-rank test). The Cox proportional hazards model showed that frailty was only an independent risk factor for poor prognosis.
Conclusions
ESD for EGC is safe for elderly patients with or without frailty. However, elderly patients with frailty have a significantly poorer prognosis than those without frailty after ESD. Our results indicate that the frailty evaluation may be helpful to determine whether ESD for EGC should be performed. Geriatr Gerontol Int 2020; 20: 461–466.
References
- 1Ferlay J, Soerjomataram I, Dikshit R et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136: E359–E386.
- 2Fock KM, Talley N, Moayyedi P et al. Asia-Pacific consensus guidelines on gastric cancer prevention. J Gastroenterol Hepatol 2008; 23: 351–365.
- 3Sano T, Kobori O, Muto T. Lymph node metastasis from early gastric cancer: endoscopic resection of tumour. Br J Surg 1992; 79: 241–244.
- 4Kim SG, Park CM, Lee NR et al. Long-term clinical outcomes of endoscopic submucosal dissection in patients with early gastric cancer: a prospective multicenter cohort study. Gut Liver 2018; 15: 402–410.
- 5Tanabe S, Ishido K, Higuchi K et al. Long-term outcomes of endoscopic submucosal dissection for early gastric cancer: a retrospective comparison with conventional endoscopic resection in a single center. Gastric Cancer 2014; 17: 130–136.
- 6Ohnita K, Isomoto H, Shikuwa S et al. Early and long-term outcomes of endoscopic submucosal dissection for early gastric cancer in a large patient series. Exp Ther Med 2014; 7: 594–598.
- 7Campbell AJ, Buchner DM. Unstable disability and the fluctuations of frailty. Age Ageing 1997; 26: 315–318.
- 8Fried LP, Tangen CM, Walston J et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56: M146–M156.
- 9Kulmala J, Nykänen I, Hartikainen S. Frailty as a predictor of all-cause mortality in older men and women. Geriatr Gerontol Int 2014; 14: 899–905.
- 10Partridge JS, Harari D, Dhesi JK. Frailty in the older surgical patient: a review. Age Ageing 2012; 41: 142–147.
- 11Makary MA, Segev DL, Pronovost PJ et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg 2010; 210: 901–908.
- 12Adams P, Ghanem T, Stachler R, Hall F, Velanovich V, Rubinfeld I. Frailty as a predictor of morbidity and mortality in inpatient head and neck surgery. JAMA Otolaryngol Head Neck Surg 2013; 139: 783–789.
- 13Robinson TN, Wallace JI, Wu DS et al. Accumulated frailty characteristics predict postoperative discharge institutionalization in the geriatric patient. J Am Coll Surg 2011; 213: 37–42.
- 14Kakushima N, Fujishiro M, Kodashima S et al. Technical feasibility of endoscopic submucosal dissection for gastric neoplasms in the elderly Japanese population. J Gastroenterol Hepatol 2007; 22: 311–314.
- 15Tokioka S, Umegaki E, Murano M et al. Utility and problems of endoscopic submucosal dissection for early gastric cancer in elderly patients. J Gastroenterol Hepatol 2012; 27: 63–69.
- 16 Clinical Frailty Scale. Geriatric Medicine Research – Dalhousie University. Faculty of Medicine, Geriatric Medicine Research, Research/Projects, Clinical Frailty Scale©. Halifax: Dalhousie University, 2015. [Cited 31 Mar 2018.] Available from URL: http://geriatricresearch.medicine.dal.ca/clinical_frailty_scale.htm
- 17Rockwood K, Song X, MacKnight C et al. A global clinical measure of fitness and frailty in elderly people. CMAJ 2005; 173: 489–495.
- 18Okabe H, Ohsaki T, Ogawa K et al. Frailty predicts severe postoperative complications after elective colorectal surgery. Am J Surg 2019; 4: 677–681.
- 19 American Society of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists. Practice guidelines for sedation and analgesia by non-anesthesiologists. Anesthesiology 2002; 96: 1004–1017.
- 20Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987; 40: 373–383.
- 21Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients [in Japanese with an English abstract]. Nihon Geka Gakkai Zasshi 1984; 85: 1001–1005.
- 22Hirashima M, Higuchi S, Sakamoto K, Nishiyama T, Okada H. The ratio of neutrophils to lymphocytes and the phenotypes of neutrophils in patients with early gastric cancer. J Cancer Res Clin Oncol 1998; 124: 329–324.
- 23Proctor MJ, Morrison DS, Talwar D et al. An inflammation-based prognostic score (mGPS) predicts cancer survival independent of tumour site: a Glasgow Inflammation Outcome Study. Br J Cancer 2011; 104: 726–734.
- 24 Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer 2017; 20: 1–19.
- 25 Japanese Gastric Cancer Association. Japanese classification of gastric carcinoma: 3rd English edition. Gastric Cancer 2011; 14: 101–112.
- 26Sakurai K, Tamura T, Toyokawa T et al. Low preoperative prognostic nutritional index predicts poor survival post-gastrectomy in elderly patients with gastric cancer. Ann Surg Oncol 2016; 23: 3669–3676.
- 27Mohri Y, Inoue Y, Tanaka K, Hiro J, Uchida K, Kusunoki M. Prognostic nutritional index predicts postoperative outcome in colorectal cancer. World J Surg 2013; 37: 2688–2692.
- 28Kanda M, Fujii T, Kodera Y, Nagai S, Takeda S, Nakao A. Nutritional predictors of postoperative outcome in pancreatic cancer. Br J Surg 2011; 98: 268–274.
- 29 Ministry of Internal Affairs and Communications Statistics Bureau. Average life expectancy of Japanese population. [Cited 3 Feb 2020.] Available from URL: http://www.stat.go.jp/data/nihon/02.htm
- 30Abe N, Gotoda T, Hirasawa T et al. Multicenter study of the long-term outcomes of endoscopic submucosal dissection for early gastric cancer in patients 80 years of age or older. Gastric Cancer 2012; 15: 70–75.
