J Cancer 2016; 7(1):14-21. doi:10.7150/jca.13126

Research Paper

To Operate or Not: Prediction of 3-Month Postoperative Mortality in Geriatric Cancer Patients

Wen-Chi Chou1,3, Keng-Hao Liu2, Chang-Hsien Lu4, Yu-Shin Hung1, Miao-Fen Chen5, Yu-Fan Cheng6, Cheng-Hsu Wang7, Yung-Chang Lin1✉, Ta-Sen Yeh2,3✉

1. Department of Medical Oncology, Chang Gung Memorial Hospital, LinKou
2. Department of Surgery, Chang Gung Memorial Hospital, LinKou
3. Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University
4. Department of Medical Oncology, Chang Gung Memorial Hospital, Chiayi
5. Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi
6. Department of Radiology, Chang Gung Memorial Hospital, Kaoshiung
7. Department of Medical Oncology, Chang Gung Memorial Hospital at Keelung, Chang Gung University College of Medicine, Taiwan

Abstract

Context: Appropriate selection of aging patient who fit for cancer surgery is an art-of-state.

Objectives: This study aimed to identify predictive factors pertinent to 3-month postoperative mortality in geriatric cancer patients.

Methods: A total of 8,425 patients over 70 years old with solid cancer received radical surgery between 2007 and 2012 at four affiliated hospitals of the Chang Gung Memorial Hospital were included. The clinical variables of patients who died within 3 months post-surgery were analyzed retrospectively. Recursive partitioning analysis (RPA) was performed by randomly selecting 50% of the patients (testing set) to identify specific groups of patients with the lowest and highest probability of 3-month postoperative mortality. The remaining 50% were used as validation set of the model.

Results: Patients' gender, Eastern Cooperative Oncology Group performance (ECOG scale), Charlson comorbidity index (CCI), American Society of Anesthesiologist physical status, age, tumor staging, and mode of admission were independent variables that predicted 3-month postoperative mortality. The RPA model identified patients with an ECOG scale of 0-2, localized tumor stage, and a CCI of 0-2 as having the lowest probability of 3-month postoperative mortality (1.1% and 1.3% in the testing set and validation set, respectively). Conversely, an ECOG scale of 3-4 and a CCI >2 were associated with the highest probability of 3-month postoperative mortality (55.2% and 47.8% in the testing set and validation set, respectively).

Conclusion: We identified ECOG scale and CCI score were the two most influencing factors that determined 3-month postoperative mortality in geriatric cancer patients.

Keywords: postoperative mortality, solid cancer, geriatric patients, predictive factors

This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY-NC) License. See http://ivyspring.com/terms for full terms and conditions.
How to cite this article:
Chou WC, Liu KH, Lu CH, Hung YS, Chen MF, Cheng YF, Wang CH, Lin YC, Yeh TS. To Operate or Not: Prediction of 3-Month Postoperative Mortality in Geriatric Cancer Patients. J Cancer 2016; 7(1):14-21. doi:10.7150/jca.13126. Available from http://www.jcancer.org/v07p0014.htm