Preoperative High C-Reactive Protein to Albumin Ratio Predicts Short- and Long-Term Postoperative Outcomes in Elderly Gastric Cancer Patients
by
Yuki Takemoto
1, 
Kazuaki Tanabe
2,*, 
Emi Chikuie
1,
Yoshihiro Saeki
1,
Hiroshi Ota
1,
Nozomi Karakuchi
1,
Akihiro Kohata
1 and
Hideki Ohdan
1 1
Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan
2
Department of Perioperative and Critical Care Management, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima 734-8551, Japan
*
Author to whom correspondence should be addressed.
Cancers 2024, 16(3), 616; https://doi.org/10.3390/cancers16030616
Submission received: 17 December 2023
/
Revised: 12 January 2024
/
Accepted: 29 January 2024
/
Published: 31 January 2024
(This article belongs to the Special Issue Advances in the Prognosis of Gastrointestinal Cancers)
Simple Summary
Individual differences exist in the tolerability of surgical intervention among elderly patients, and it is necessary for appropriate treatment planning. The aim of our retrospective study was to investigate the efficacy of markers of preoperative inflammatory and nutritional status and identified perioperative high-risk elderly patients with gastric cancer. We analyzed whether preoperative inflammatory nutritional markers of 571 gastric cancer patients (<65 years old; n = 192, ≥65 years old; n = 379) can predict postoperative short-term and long-term outcomes. Preoperative high C-reactive albumin ratio (CAR) was not only associated with the occurrence of postoperative complications but also with poor prognosis in elderly gastric cancer patients. However, these trends were not observed among younger patients. The importance of these findings is that CAR has the potential to be used as a simple tool to predict short- and long-term postoperative outcomes that reflect the nutritional inflammatory status of the elde.
Abstract
Individualized preoperative assessment of the general condition of elderly patients with gastric cancer is necessary for appropriate surgical treatment planning. This study investigated the efficacy of preoperative markers that could be easily calculated from preoperative peripheral blood to predict the short- and long-term postoperative outcomes of gastrectomy. In total, 571 patients who underwent R0 surgical resection for gastric cancer were enrolled. In the elderly patient group (≥65 years old), univariate analyses revealed that the incidence of postoperative complications was associated with poor performance status (p = 0.012), more comorbidities (p = 0.020), high C-reactive protein to albumin ratio (CAR, p = 0.003), total gastrectomy (p = 0.003), open approach (p = 0.034), blood transfusion (p = 0.002), and advanced cancer (p = 0.003). Multivariate analysis showed that a high CAR was associated with a high incidence of postoperative complications (p = 0.046). High CAR was also associated with poor OS (p = 0.015) and RFS (p = 0.035). However, these trends were not observed among younger patients (<65 years old). Preoperative CAR may play a significant role in predicting short- and long-term surgical outcomes, particularly in elderly patients with gastric cancer.
