Predictors of 1‐year mortality after gastrectomy for gastric cancer

Abstract

AbstractPurposeOne‐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.