Scoring system for predicting the prognosis of elderly gastric cancer patients after endoscopic submucosal dissection

Objectives Comprehensive assessments of the long-term outcomes of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) in the elderly are unavailable. We aimed to create a scoring system to predict the long-term prognosis after ESD for EGC among patients aged >= 75 years. Methods We conducted retrospective studies of two cohorts: a single-center cohort (2006-2011) for developing the scoring system, and a multicenter cohort for validating the developed system (2012-2016). In the development cohort, factors related to death after ESD were identified using multivariable Cox regression analysis, and a predictive scoring system was developed. In the validation cohort, the scoring system was validated in 295 patients. Results In the development cohort, Charlson comorbidity index (CCI) >= 3 (hazard ratio [HR] 3.017), high psoas muscle index (PMI) (HR 2.206), and age >= 80 years (HR 1.978) were significantly related to overall survival after ESD. Therefore, high CCI, low PMI, and age >= 80 years were assigned 1 point each. The patients were categorized into low (<= 1 point) and high (>= 2 points) score groups based on their total scores. In the validation cohort, 184 and 111 patients were assigned to the low- and high-score groups, respectively. In comparisons based on Kaplan-Meier curves, the 5-year survival rate was 91.5% in the low-score group and 57.8% in the high-score group (log-rank test; P < 0.001). Conclusion Our scoring system including high CCI, low PMI, and age >= 80 years could stratify the long-term prognosis of elderly patients aged >= 75 years after ESD for EGC.

Automated summary

This study aimed to develop a scoring system to predict the long-term prognosis after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) among patients aged >= 75 years. Factors such as Charlson comorbidity index (CCI), psoas muscle index (PMI), and age were identified to be significantly related to overall survival after ESD. The scoring system, which included high CCI, low PMI, and age >= 80 years, successfully stratified the long-term prognosis of elderly patients after ESD.