Abstract
IntroductionTo assess the ability of the Age-Adjusted Charlson Comorbidity Index (ACCI) to predict survival after radical gastrectomy in patients with gastric cancer (GC).MethodData from patients with GC who underwent radical gastrectomy from January 2008 to December 2012 in Fujian Medical University Union Hospital were retrospectively analyzed. Patients were categorized into either high ACCI group or low ACCI group based on the effect of ACCI on long-term GC prognosis. 1:1 propensity score matching (PSM) was used to reduce confounding bias. To further analyze the impact of ACCI on the long-term prognosis of patients after radical gastrectomy, a nomogram was built based on the Cox proportional hazards regression model.ResultsA total of 1476 patients were included in the analysis. After PSM, there was no statistically significant differences in tumor location, tumor size and tumor stage between low ACCI group (429 cases) and high ACCI group (429 cases) (all P > 0.05). Before and after PSM, the incidence of postoperative complications in high ACCI group was significantly higher than that in low ACCI group (P < 0.05). The 5-year overall survival rate (OS) in low ACCI group was significantly higher than that in high ACCI group. Multivariate analysis showed that ACCI was an independent risk factor for OS (P < 0.05). The Harrell’s C-statistics (C-index) of TNMA, a prognostic evaluation system combining ACCI and TNM staging system, was significantly higher than that of TNM staging system in both the modeling and validation groups (all P < 0.05).ConclusionsACCI was an independent risk factor for the long-term prognosis of GC patients after radical gastrectomy that could effectively improve the predictive efficacy of the TNM staging system for GC.
Highlights
To assess the ability of the Age-Adjusted Charlson Comorbidity Index (ACCI) to predict survival after radical gastrectomy in patients with gastric cancer (GC)
Patients were categorized into two groups (ACCI category): a low ACCI group (ACCI = 0–2; 1047 cases, 70.9%), and a high ACCI group (ACCI = 3–8; 429 cases, 29.1%)
Those who were older than 70 years old were all included in high ACCI group
Summary
To assess the ability of the Age-Adjusted Charlson Comorbidity Index (ACCI) to predict survival after radical gastrectomy in patients with gastric cancer (GC). As the functional reserve of the human body tends to decline with age, elderly patients often have more comorbidities [4] and are more likely to have postoperative complications including death [5,6,7,8,9]. Investigators have determined the predictive value of the ACCI on the long-term prognosis of patients with other malignant tumors (such as ovarian cancer, prostate cancer, pancreatic cancer, and colorectal cancer) [11,12,13,14,15]. The clinicopathological data of patients with radical gastrectomy from 2008 to 2012 were included in our study to evaluate the predictive value of the ACCI on the long-term prognosis of patients with GC
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