School of Nursing, Nanjing Medical University, Nanjing, China.
Department of Colorectal Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Geriatr Gerontol Int. 2023 Mar;23(3):205-212. doi: 10.1111/ggi.14544. Epub 2023 Feb 6.
Nutritional status and frailty are significant indicators reflecting physiological reserve. We sought to establish and validate a web-based calculator containing the Geriatric Nutritional Risk Index (GNRI) and the Tilburg Frailty Indicator (TFI) together with general clinical information to predict total complications among elderly patients with gastric cancer.
This was a prospective cohort study of 582 elderly patients with gastric cancer in a tertiary hospital in China. Nutritional status and frailty were assessed by the GNRI and the TFI, respectively. The nomogram was built and further converted into a web-based calculator. The receiver operating characteristic analysis was performed to evaluate the discrimination of the nomogram. Calibration was assessed using the calibration curve and Hosmer-Lemeshow test via the bootstrap resampling procedure. The decision curve analyses (DCAs) were employed to quantify the net benefits of a certain threshold probability for assessing the clinical values.
The GNRI (odds ratio [OR], 0.921; 95% confidence interval [CI], 0.895-0.949; P < 0.001), the TFI (OR, 1.243; 95% CI, 1.113-1.386; P < 0.001), surgical approach (OR, 1.913; 95% CI, 1.073-3.408; P = 0.028) and comorbidity (OR = 1.599, 95%CI = 1.028-2.486, P = 0.037) were independently associated with total complications. The nomogram demonstrated good discrimination (area under the receiver operating characteristic curve: training cohort, 0.735; validation cohort, 0.777) and calibration (P = 0.135). The DCA curves of the nomogram also showed good positive net benefits.
The web-based calculator incorporating the GNRI, the TFI, surgical approach, and comorbidity could successfully predict total complications among elderly patients with gastric cancer with good accuracy in a convenient manner. Geriatr Gerontol Int 2023; 23: 205-212.
营养状况和虚弱是反映生理储备的重要指标。我们旨在建立和验证一个包含老年营养风险指数（GNRI）和蒂尔堡虚弱指数（TFI）以及一般临床信息的网络计算器，以预测老年胃癌患者的总并发症。
这是一项在中国一家三级医院进行的老年胃癌患者的前瞻性队列研究。营养状况和虚弱分别通过 GNRI 和 TFI 进行评估。建立了列线图，并进一步转化为网络计算器。通过bootstrap 重采样程序进行接收者操作特征分析，以评估列线图的区分度。通过校准曲线和 Hosmer-Lemeshow 检验评估校准。通过决策曲线分析（DCA）来量化评估特定阈值概率的临床价值的净收益。
GNRI（比值比 [OR]，0.921；95%置信区间 [CI]，0.895-0.949；P<0.001）、TFI（OR，1.243；95%CI，1.113-1.386；P<0.001）、手术方式（OR，1.913；95%CI，1.073-3.408；P=0.028）和合并症（OR=1.599，95%CI=1.028-2.486，P=0.037）与总并发症独立相关。列线图具有良好的区分度（训练队列的受试者工作特征曲线下面积：0.735；验证队列：0.777）和校准（P=0.135）。列线图的 DCA 曲线也显示出良好的正净效益。
该网络计算器纳入 GNRI、TFI、手术方式和合并症，可方便地以较高的准确性预测老年胃癌患者的总并发症。老年医学与老年病学杂志 2023；23：205-212。
