Influencing factors of preoperative debilitation in elderly patients with esophageal cancer and construction of a predictive nomogram model_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

SHI Yao ¹ , ZHOU Yun ² , WANG Yun ³ , PENG Lin ¹ , LU Jingwen ¹ ,  NI Yiqian ²

1. Department of Critical Care Medicine, The First Affiliated Hospital of Naval Military Medical University, Shanghai, 200433, P. R. China;
2. Department of Thoracic Surgery, The First Affiliated Hospital of Naval Military Medical University, Shanghai, 200433, P. R. China;
3. College of Nursing, Hunan University of Traditional Chinese Medicine, Changsha, 410208, P. R. China;

Corresponding author：

NI Yiqian, Email: 14435851@qq.com

Keywords：

Elderly patients; esophageal cancer; debility; risk prediction; Nomogram

DOI：

10.7507/1007-4848.202411054

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Objective To analyze the influencing factors of preoperative frailty in elderly esophageal cancer patients, and to construct and evaluate a nomogram model. Methods Elderly esophageal cancer patients hospitalized in the First Affiliated Hospital of Navy Medical University from January 2022 to August 2024 were selected. General information of the patients was collected, and the patients were divided into a frailty group and a non-frailty group according to the frailty score. Single-factor and multi-factor logistic regression analysis were used to screen the independent influencing factors of preoperative frailty in elderly esophageal cancer patients, and the nomogram model was constructed and evaluated accordingly. Results A total of 332 elderly esophageal cancer patients were included, including 256 males and 76 females, with an average age of (69.71±5.95) years. The incidence of preoperative frailty was 45.48%. Multivariate analysis showed that age≥70 years [OR=2.986, 95%CI (1.796, 4.965), P<0.001], basic diseases≥2 types [OR=3.129, 95%CI (1.794, 5.457), P=0.012], self-care ability [OR=2.599, 95%CI (1.512, 4.467), P<0.001], and depression [OR=3.784, 95%CI (2.135, 6.706), P=0.005] were independent risk factors for preoperative frailty in elderly esophageal cancer patients. The nomogram model was constructed as follows: Z=−2.038+1.094×(age≥70 years)+1.141×(basic diseases≥2 types)+0.955×self-care ability (non-independent)+1.331×depression, with an area under the receiver operating characteristic (ROC) curve of 0.802 [95%CI (0.756, 0.847)], and the sensitivity and specificity were 78.8% and 65.2%, respectively. The goodness of fit test showed that the model had good discrimination and calibration (χ²=6.64, P>0.05). Conclusion Age≥70 years, basic diseases≥2 types, self-care ability, and depression are independent risk factors for preoperative frailty in elderly esophageal cancer patients. The constructed nomogram model shows good predictive performance and can identify elderly esophageal cancer patients with preoperative frailty, providing a reference for the formulation of corresponding intervention measures.

1.	Jang JY, Oh D, Noh JM, et al. Prognostic impact of muscle mass loss in elderly patients with oesophageal cancer receiving neoadjuvant chemoradiation therapy. J Cachexia Sarcopenia Muscle, 2024, 15(3): 1167-1176.
2.	Xu C, Xi M, Moreno A, et al. Definitive chemoradiation therapy for esophageal cancer in the elderly: Clinical outcomes for patients exceeding 80 years old. Int J Radiat Oncol Biol Phys, 2017, 98(4): 811-819.
3.	van Doesburg JR, Luttikhold J, Lindblad M, et al. Diagnostic workup for esophageal cancer patients can be improved with checklists and clearer protocols: A comparative study between two tertiary centers in Europe. Eur J Surg Oncol, 2024, 50(2): 107318.
4.	Yoshida N, Yamamoto H, Baba H, et al. Can minimally invasive esophagectomy replace open esophagectomy for esophageal cancer? Latest analysis of 24, 233 esophagectomies from the Japanese national clinical database. Ann Surg, 2020, 272(1): 118-124.
5.	Bracken-Clarke D, Farooq AR, Horgan AM. Management of locally advanced and metastatic esophageal cancer in the older population. Curr Oncol Rep, 2018, 20(12): 99.
6.	Kim DH, Rockwood K. Frailty in older adults. N Engl J Med, 2024, 391(6): 538-548.
7.	Chen X, Zheng R, Xu X, et al. Frailty and health-related quality of life in elderly patients undergoing esophageal cancer surgery: A longitudinal study. Asian Nurs Res (Korean Soc Nurs Sci), 2024, 18(2): 125-133.
8.	Balachandran VP, Gonen M, Smith JJ, et al. Nomograms in oncology: More than meets the eye. Lancet Oncol, 2015, 16(4): e173-80.
9.	Gobbens RJ, Luijkx KG, Wijnen-Sponselee MT, Schols JM. In search of an integral conceptual definition of frailty: Opinions of experts. J Am Med Dir Assoc, 2010, 11(5): 338-43.
10.	奚兴, 郭桂芳, 孙静. 中文版Tilburg衰弱评估量表的信效度研究. 护理学报, 2013, 20(16): 1-5.Xi X, Guo GF, Sun J. A reliability study of the Chinese version of the Tilburg Frailty Assessment Scale. J Nurs, 2013, 20(16): 1-5.
11.	蔡业峰, 贾真, 李伟峰, 等. 中文版Barthel指数对多中心测评缺血性卒中患者预后的研究. 中国脑血管病杂志, 2007, 4(11): 486-490.Cai YF, Jia Z, Li WF, et al. Chinese version of the Barthel Index for multicenter prognostic assessment of ischemic stroke patients. Chin J Cerebrovasc Dis, 2007, 4(11): 486-490.
12.	Mahoney FI, Barthel DW. Functional evaluation: The Barthel Index. Md State Med J, 1965, 5(14): 61-5.
13.	Burke WJ, Roccaforte WH, Wengel SP. The short form of the Geriatric Depression Scale: A comparison with the 30-item form. J Geriatr Psychiatry Neurol, 1991, 4(3): 173-8.
14.	梅锦荣. 老年抑郁量表和普通健康问卷(简本)信度和效度的研究. 中华精神科杂志, 1999, 32(1): 40-42.Mei JR. A study of the reliability and validity of the Geriatric Depression Scale and the General Health Questionnaire (short version). Chin J Psychiatry, 1999, 32(1): 40-42.
15.	陆小英, 赵存凤, 张婷婷, 等. “长海痛尺”在疼痛评估中的应用. 解放军护理杂志, 2003, 20(4): 6-7.Lu XY, Zhao CF, Zhang TT, et al. Application of "Changhai pain ruler" in pain assessment. PLA Nurs J, 2003, 20(4): 6-7.
16.	薛琦, 邹圣强, 乔瑶, 等. 老年食管癌患者术前衰弱状况调查. 河北医药, 2022, 44(11): 1732-1735.Xue Q, Zou SQ, Qiao Y, et al. Survey on preoperative debilitating condition of elderly esophageal cancer patients. Hebei Med J, 2022, 44(11): 1732-1735.
17.	North MS, Fiske ST. Modern attitudes toward older adults in the aging world: A cross-cultural meta-analysis. Psychol Bull, 2015, 141(5): 993-1021.
18.	Miao J, Wu X, Sun X. Neighborhood, social cohesion, and the elderly's depression in Shanghai. Soc Sci Med, 2019, 229: 134-143.
19.	Morito A, Harada K, Iwatsuki M, et al. Frailty assessed by the Clinical Frailty Scale is associated with prognosis after esophagectomy. Ann Surg Oncol, 2023, 30(6): 3725-3732.
20.	Boerner T, Sewell M, Tin AL, et al. A novel frailty index can predict the short-term outcomes of esophagectomy in older patients with esophageal cancer. Curr Oncol, 2024, 31(8): 4685-4694.
21.	薛琦. 老年食管癌患者术前衰弱调查及多维预康复干预效果研究. 江苏大学, 2022.Xue Q. Research on preoperative debilitation survey and the effect of multidimensional prehabilitation intervention in elderly esophageal cancer patients. Jiangsu University, 2022.
22.	Ravensbergen C, van Holstein Y, Hagenaars S, et al. Association of biological age with tumor microenvironment in patients with esophageal adenocarcinoma. Gerontology, 2024, 70(4): 337-350.
23.	Baydoun M, Barton DL, Arslanian-Engoren C. A cancer specific middle-range theory of symptom self-care management: A theory synthesis. J Adv Nurs, 2018, 74(12): 2935-2946.

1. Jang JY, Oh D, Noh JM, et al. Prognostic impact of muscle mass loss in elderly patients with oesophageal cancer receiving neoadjuvant chemoradiation therapy. J Cachexia Sarcopenia Muscle, 2024, 15(3): 1167-1176.
2. Xu C, Xi M, Moreno A, et al. Definitive chemoradiation therapy for esophageal cancer in the elderly: Clinical outcomes for patients exceeding 80 years old. Int J Radiat Oncol Biol Phys, 2017, 98(4): 811-819.
3. van Doesburg JR, Luttikhold J, Lindblad M, et al. Diagnostic workup for esophageal cancer patients can be improved with checklists and clearer protocols: A comparative study between two tertiary centers in Europe. Eur J Surg Oncol, 2024, 50(2): 107318.
4. Yoshida N, Yamamoto H, Baba H, et al. Can minimally invasive esophagectomy replace open esophagectomy for esophageal cancer? Latest analysis of 24, 233 esophagectomies from the Japanese national clinical database. Ann Surg, 2020, 272(1): 118-124.
5. Bracken-Clarke D, Farooq AR, Horgan AM. Management of locally advanced and metastatic esophageal cancer in the older population. Curr Oncol Rep, 2018, 20(12): 99.
6. Kim DH, Rockwood K. Frailty in older adults. N Engl J Med, 2024, 391(6): 538-548.
7. Chen X, Zheng R, Xu X, et al. Frailty and health-related quality of life in elderly patients undergoing esophageal cancer surgery: A longitudinal study. Asian Nurs Res (Korean Soc Nurs Sci), 2024, 18(2): 125-133.
8. Balachandran VP, Gonen M, Smith JJ, et al. Nomograms in oncology: More than meets the eye. Lancet Oncol, 2015, 16(4): e173-80.
9. Gobbens RJ, Luijkx KG, Wijnen-Sponselee MT, Schols JM. In search of an integral conceptual definition of frailty: Opinions of experts. J Am Med Dir Assoc, 2010, 11(5): 338-43.
10. 奚兴, 郭桂芳, 孙静. 中文版Tilburg衰弱评估量表的信效度研究. 护理学报, 2013, 20(16): 1-5.Xi X, Guo GF, Sun J. A reliability study of the Chinese version of the Tilburg Frailty Assessment Scale. J Nurs, 2013, 20(16): 1-5.
11. 蔡业峰, 贾真, 李伟峰, 等. 中文版Barthel指数对多中心测评缺血性卒中患者预后的研究. 中国脑血管病杂志, 2007, 4(11): 486-490.Cai YF, Jia Z, Li WF, et al. Chinese version of the Barthel Index for multicenter prognostic assessment of ischemic stroke patients. Chin J Cerebrovasc Dis, 2007, 4(11): 486-490.
12. Mahoney FI, Barthel DW. Functional evaluation: The Barthel Index. Md State Med J, 1965, 5(14): 61-5.
13. Burke WJ, Roccaforte WH, Wengel SP. The short form of the Geriatric Depression Scale: A comparison with the 30-item form. J Geriatr Psychiatry Neurol, 1991, 4(3): 173-8.
14. 梅锦荣. 老年抑郁量表和普通健康问卷(简本)信度和效度的研究. 中华精神科杂志, 1999, 32(1): 40-42.Mei JR. A study of the reliability and validity of the Geriatric Depression Scale and the General Health Questionnaire (short version). Chin J Psychiatry, 1999, 32(1): 40-42.
15. 陆小英, 赵存凤, 张婷婷, 等. “长海痛尺”在疼痛评估中的应用. 解放军护理杂志, 2003, 20(4): 6-7.Lu XY, Zhao CF, Zhang TT, et al. Application of "Changhai pain ruler" in pain assessment. PLA Nurs J, 2003, 20(4): 6-7.
16. 薛琦, 邹圣强, 乔瑶, 等. 老年食管癌患者术前衰弱状况调查. 河北医药, 2022, 44(11): 1732-1735.Xue Q, Zou SQ, Qiao Y, et al. Survey on preoperative debilitating condition of elderly esophageal cancer patients. Hebei Med J, 2022, 44(11): 1732-1735.
17. North MS, Fiske ST. Modern attitudes toward older adults in the aging world: A cross-cultural meta-analysis. Psychol Bull, 2015, 141(5): 993-1021.
18. Miao J, Wu X, Sun X. Neighborhood, social cohesion, and the elderly's depression in Shanghai. Soc Sci Med, 2019, 229: 134-143.
19. Morito A, Harada K, Iwatsuki M, et al. Frailty assessed by the Clinical Frailty Scale is associated with prognosis after esophagectomy. Ann Surg Oncol, 2023, 30(6): 3725-3732.
20. Boerner T, Sewell M, Tin AL, et al. A novel frailty index can predict the short-term outcomes of esophagectomy in older patients with esophageal cancer. Curr Oncol, 2024, 31(8): 4685-4694.
21. 薛琦. 老年食管癌患者术前衰弱调查及多维预康复干预效果研究. 江苏大学, 2022.Xue Q. Research on preoperative debilitation survey and the effect of multidimensional prehabilitation intervention in elderly esophageal cancer patients. Jiangsu University, 2022.
22. Ravensbergen C, van Holstein Y, Hagenaars S, et al. Association of biological age with tumor microenvironment in patients with esophageal adenocarcinoma. Gerontology, 2024, 70(4): 337-350.
23. Baydoun M, Barton DL, Arslanian-Engoren C. A cancer specific middle-range theory of symptom self-care management: A theory synthesis. J Adv Nurs, 2018, 74(12): 2935-2946.

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