Predictors of 1-year mortality after gastrectomy for gastric cancer

PurposeOne-year mortality is important for referrals to specialist palliative care or advance care planning (ACP). This helps optimize comfort for those who cannot be cured or have a lower life expectancy. Few studies have investigated the risk factors for 1-year mortality after gastrectomy for gastric cancer (GC).MethodsA total of 1415 patients with gastric cancer (stages I-IV) who underwent gastrectomy between 2005 and 2020 were included. The patients were randomly assigned to the investigation group (n = 850) and validation group (n = 565) in a 3:2 ratio. In the investigation group, significant independent prognostic factors for predicting 1-year survival were identified. A scoring system for predicting 1-year mortality was developed which was validated in the validation group.ResultsMultivariate analysis revealed that the following seven variables were significant independent factors for 1-year survival: age >= 78, preoperative comorbidity, total gastrectomy, postoperative complication (Clavien-Dindo classification CD >= 3a), stage III and IV, and R2 resection. While developing a 1-year mortality score (OMS), an age >= 78 was scored 2, preoperative comorbidity, total gastrectomy, and postoperative complication (CD >= 3a) were scored 1, and stage III, IV, and R2-resection were scored 2, 3, and 3, respectively. OMS 3 had a sensitivity of 91% and a specificity of 66% for predicting death within 1 year. In the validation group, OMS 5 had a sensitivity of 55% and a specificity of 93% for predicting death within 1 year.ConclusionsOMS may provide important information and help surgeons select the timing of ACP in patients with GC.

Automated summary

This study aimed to investigate the risk factors for 1-year mortality after gastrectomy for gastric cancer and develop a scoring system for prediction. The results revealed that age, preoperative comorbidity, surgical procedure, postoperative complication, cancer stage, and surgical resection were important factors influencing 1-year survival. The scoring system could provide important information for surgeons to select the timing of advance care planning in patients with gastric cancer.