The Pre-Operative GRADE Score Is Associated with 5-Year Survival among Older Patients with Cancer Undergoing Surgery

Simple Summary The benefit of major cancer surgery among older patients may be limited, and it remains unclear how to optimally select suitable patients. By combining very simple geriatric (gait speed, and weight loss) and cancer parameters (cancer site and cancer extension), the pre-operative GRADE score > 8 was significantly associated with severe post-operative complications, and overall post-operative mortality among older patients with digestive or non-breast gynaecological cancer undergoing surgery. At the time of the first consultation, the GRADE score could help surgeons to choose the most suitable treatment strategy, avoiding under- or over-treatment, especially when a geriatric assessment is not available. We aimed to assess the prognostic value of the pre-operative GRADE score for long-term survival among older adults undergoing major surgery for digestive or non-breast gynaecological cancers. Between 2013 and 2019, 136 consecutive older adults with cancer were prospectively recruited from the PF-EC cohort study before major cancer surgery and underwent a geriatric assessment. The GRADE score includes weight loss, gait speed at the threshold of 0.8 m/s, cancer site and cancer extension. The primary outcome was post-operative 5-year mortality. Patients were classified as low risk (GRADE <= 8) or high risk (GRADE > 8) on the basis of the median score. A Cox multivariate proportional hazards regression model was performed to assess the association between pre-operative factors and 5-year mortality expressed by adjusted hazard ratio (aHR) and 95% CI. The median age was 80 years, 52% were men, 73% had colorectal cancer. The 30-day post-operative severe complication rate (Clavien-Dindo >= 3) was 37%. The 5-year post-operative mortality rate was 34.5%. A GRADE score >= 8 (aHR = 2.64 [1.34-5.21], p = 0.0002) was associated with post-operative mortality after adjustment for Body Mass Index < 21 kg/m(2) and Instrumental Activities of Daily Living <3/4. By combining very simple geriatric and cancer parameters, the pre-operative GRADE score provides a discriminant prognosis and could help to choose the most suitable treatment strategy for older cancer patients, avoiding under or over-treatment.

Automated summary

The pre-operative GRADE score, which combines simple geriatric and cancer parameters, can provide a prognosis and help surgeons choose the most suitable treatment strategy for older cancer patients undergoing major surgery for digestive or non-breast gynaecological cancers, thereby avoiding under or over-treatment.