Comprehensive geriatric assessment guiding treatment and survival in elderly digestive tumor patients: A retrospective study

Table 3 Treatment decision support framework under comprehensive geriatric assessment classification guidance (example in locally advanced stage III gastric cancer)

CGA grade	Target	Core treatment strategy	Specific example
Health	Cure	Standard neoadjuvant/adjuvant chemotherapy + radical surgery	Perioperative chemotherapy: Standard FLOT regimen (doxorubicin + oxaliplatin + fluorouracil/Leucovorin) is administered.rmed
			Surgery: Radical gastrectomy (D2 standard) is perfo
			Postoperative care: Complete all planned adjuvant chemotherapy cycles
Fragile	Control and function equally important	Optimize the standard protocol to reduce treatment-related risks and ensure successful completion of treatment	Pretreatment support: Initiate intensive nutritional support prior to chemotherapy and administer G-CSF prophylactically
			Perioperative chemotherapy: Employ the less toxic SOX (tegafur + oxaliplatin) or XELOX (capecitabine + oxaliplatin) combination regimens, with initial doses reduced to 80% of standard levels
			Surgery: Perform radical resection, followed by adjustment of adjuvant chemotherapy based on postoperative recovery
Caducity	Quality of life	Avoid high-intensity radical treatment and focus on controlling tumor-related symptoms, maintaining the feeding channel and quality of life	Nonsurgical local treatment: Palliative radiotherapy to control bleeding or pain
			Systemic treatment: Monotherapy (e.g., tegafur) or targeted therapy (e.g., trastuzumab for HER2-positive patients)
			Core measures: Enhanced nutritional support; professional pain and symptom management; if obstruction exists, perform gastrojejunostomy or place intestinal stent

CGA: Comprehensive geriatric assessment; FLOT: Folinic acid + leucovorin + oxaliplatin + docetaxel; G-CSF: Granulocyte colony-stimulating factor; SOX: S-1 + oxaliplatin; XELOX: Capecitabine + oxaliplatin.