• EORTC QLQ-C30
• FACT-G
• MOSSSS
• QOL
• immunotherapy
• oncology trials
• phase 1 cancer trial
• quality-of-life
• selection criteria
• serious adverse events

In gastric cancer patients chronological and biological age might vary greatly between patients. Age as well as American Society of Anaesthesiologists-physical status classifications are very non-specific and do not adequately predict adverse outcome. Improvements have been made such as the introduction of Charlson Comorbidity Index. Geriatric frailty is probably a better measure for patients resistance to stressors and physiological reserves. An increasing amount of evidence shows that geriatric frailty is a better predictor for adverse outcome after surgery, including gastric cancer surgery. Geriatric frailty can be assessed in a number of ways. Questionnaires such as the Groningen Frailty Indicator provide an ease and low cost method for gauging the presence of frailty in gastric cancer patients. This can then be used to provide a better preoperative risk assessment in these patients and improve decision making.

• Gastric cancer
• Surgery
• Geriatric frailty

• Clinical assessment
• Clinical decisions
• Communication
• Prognosis

• Aged
• Health Status Indicators
• Humans
• Inpatients
• Prognosis
• Terminally Ill
• Triage/methods
• Uncertainty

Gastric cancer remains a significant health problem worldwide and surgery is currently the only potentially curative treatment option. Gastric cancer surgery is generally considered to be high risk surgery and five-year survival rates are poor, therefore a continuous strive to improve outcomes for these patients is warranted. Fortunately, in the last decades several potential advances have been introduced that intervene at various stages of the treatment process. This review provides an overview of methods implemented in pre-, intra- and postoperative stage of gastric cancer surgery to improve outcome. Better preoperative risk assessment using comorbidity index (e.g., Charlson comorbidity index), assessment of nutritional status (e.g., short nutritional assessment questionnaire, nutritional risk screening - 2002) and frailty assessment (Groningen frailty indicator, Edmonton frail scale, Hopkins frailty) was introduced. Also preoperative optimization of patients using prehabilitation has future potential. Implementation of fast-track or enhanced recovery after surgery programs is showing promising results, although future studies have to determine what the exact optimal strategy is. Introduction of laparoscopic surgery has shown improvement of results as well as optimization of lymph node dissection. Hyperthermic intraperitoneal chemotherapy has not shown to be beneficial in peritoneal metastatic disease thus far. Advances in postoperative care include optimal timing of oral diet, which has been shown to reduce hospital stay. In general, hospital volume, i.e., centralization, and clinical audits might further improve the outcome in gastric cancer surgery. In conclusion, progress has been made in improving the surgical treatment of gastric cancer. However, gastric cancer treatment is high risk surgery and many areas for future research remain.

• Gastric cancer
• Laparoscopic surgery
• Risk assessment
• Surgical outcome
• Postoperative care

• Comorbidity
• Decision Support Techniques
• Gastrectomy/adverse effects
• Gastrectomy/methods
• Gastrectomy/mortality
• Health Status
• Humans
• Laparoscopy
• Outcome and Process Assessment, Health Care
• Patient Selection
• Perioperative Care
• Predictive Value of Tests
• Quality Improvement
• Quality Indicators, Health Care
• Risk Assessment
• Risk Factors
• Stomach Neoplasms/mortality
• Stomach Neoplasms/pathology
• Stomach Neoplasms/surgery
• Treatment Outcome

We did a retrospective study to understand the prognostic effects of preoperative blood transfusions in stomach cancer surgery.

Data for 1,360 patients who underwent gastrectomy for stomach cancer between 2001 and 2009 were retrospectively reviewed. We analyzed factors that affect preoperative transfusion and clinicopathologic features. We also analyzed 5-year and overall survival rates of the transfusion and non transfusion subgroups.

Sixty patients (4.4%) required blood transfusion within the preoperative period. The transfused group included patients who took aspirin or clopidogrel (P<0.001), with more advanced T stages (P<0.001), with more advanced nodal metastasis (P=0.00), and with more advanced stages (P=0.00) than the non transfusion group. On multivariate analysis, preoperative transfusion was a statistically significant negative influence on 5-year survival and overall survival rates (58.2% vs 79.9% (P=0.00), 58.2% vs 76.8% (P=0.00)). Applying Cox-regression analyses, blood transfusion did appear to have an effect on prognosis and on 5-year and overall survival rates.

We found a direct negative relation between preoperative transfusion and long term prognosis in patients receiving gastric cancer surgery.

• Blood transfusion
• Prognosis
• Stomach neoplasm

Allogeneic conventional hematopoietic cell transplantation (HCT) following high-dose, myeloablative conditioning regimens has been used since the 1970’s as potentially curative treatment for patients with malignant, hematological disorders. The toxicities of conditioning regimens have limited conventional HCT to relatively young patients in otherwise good medical condition. With the development of less toxic nonmyeloablative regimens and improvements in supportive care, increasing numbers of older and medically infirm patients have been treated by allogeneic HCT. Until recently, there has been almost no effort to evaluate the prevalence of comorbidities among HCT recipients and their impact on outcomes. We first evaluated the Charlson Comorbidity Index (CCI) developed for patients with solid malignancies, for this purpose. While useful, it lacked sensitivity and specificity for the HCT setting. We next introduced the HCT-specific comorbidity index (HCT-CI) which was based on objective laboratory data to better define comorbidities. Here, we describe this development and illustrate the usefulness of the HCT-CI in predicting HCT outcomes in patients with myeloid and lymphoid malignancies undergoing allogeneic transplantation.

• Comorbidity
• Hematopoietic Stem Cell Transplantation/mortality
• Humans
• Leukemia, Myeloid, Acute/mortality
• Leukemia, Myeloid, Acute/therapy
• Prevalence
• Prognosis
• Remission Induction
• Sensitivity and Specificity
• Severity of Illness Index
• Survival Rate

• CA18029 NCI NIH HHS
• P01 CA018029 NCI NIH HHS
• P30 CA015704 NCI NIH HHS
• CA78902 NCI NIH HHS
• R00 HL088021 NHLBI NIH HHS
• CA15704 NCI NIH HHS
• P01 CA078902 NCI NIH HHS
• K99 HL088021 NHLBI NIH HHS
• HL088021 NHLBI NIH HHS

• non-small-cell lung cancer
• comorbidities
• prognosis

• Carcinoma, Non-Small-Cell Lung/diagnosis
• Carcinoma, Non-Small-Cell Lung/epidemiology
• Carcinoma, Non-Small-Cell Lung/pathology
• Comorbidity
• Female
• Humans
• Male
• Middle Aged
• Prognosis
• Reproducibility of Results
• Survival Rate

• Adolescent
• Adult
• Aged
• Cause of Death
• Child
• Child, Preschool
• Comorbidity
• Contraindications
• Female
• Humans
• Infant
• Male
• Middle Aged
• Prognosis
• Proportional Hazards Models
• Reproducibility of Results
• Risk Assessment
• Stem Cell Transplantation
• Survival Rate
• Transplantation, Homologous
• Treatment Outcome

• CA18029 NCI NIH HHS
• HL36444 NHLBI NIH HHS
• CA78902 NCI NIH HHS
• CA92058 NCI NIH HHS
• CA49605 NCI NIH HHS
• CA15704 NCI NIH HHS
• P01 CA078902 NCI NIH HHS

Risk adjustment and stratification play an important role in quality assurance and in clinical research. The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) is a patient risk prediction model based on 12 patient characteristics and 6 characteristics of the surgery performed. However, because the POSSUM was developed for quality assessment in general surgical units, its performance within specific subgroups still requires evaluation.

The aim of the present study was to assess the accuracy of POSSUM in predicting mortality and morbidity in patients with gastric cancer undergoing D2-gastrectomy.

137 patients with gastric cancer undergoing gastrectomy were included in this study. Detailed, standardized risk assessments and thorough documentation of the post-operative courses were performed prospectively, and the POSSUM scores were then calculated.

The 30- and 90- day mortality rates were 3.6% (n = 5) and 5.8% (n = 8), respectively. 65.7% (n = 90) of patients had normal postoperative courses without major complications, 14.6% (n = 20) had moderate and 13.9% (n = 19) had severe complications. The number of mortalities predicted by the POSSUM-Mortality Risk Score (R1) was double the actual number of mortalities occurring in the median and high-risk groups, and was more than eight times the actual number of mortalities occurring in the low-risk group (R1 < 20%). However, the calculated R1 predicted rather well in terms of severe morbidity or post-operative death in each risk group: in predicted low risk patients the actual occurrence rate (AR) of severe morbidity or post-operative death was 14%, for predicted medium risk patients the AR was 23%, and for predicted high risk patients the AR was 50% (p < 0.05). The POSSUM-Morbidity Risk Score (R2) overestimated the risk of morbidity.

The POSSUM Score may be beneficial and can be used for assessment of the peri- and post-operative courses of patients with gastric carcinoma undergoing D2-gastrectomy. However, none of the scores examined here are useful for preoperative prediction of postoperative course.

• Adult
• Aged
• Aged, 80 and over
• Female
• Gastrectomy/adverse effects
• Gastrectomy/mortality
• Humans
• Lymph Node Excision/adverse effects
• Male
• Middle Aged
• Morbidity
• Postoperative Complications/classification
• Postoperative Complications/mortality
• Predictive Value of Tests
• Risk Assessment
• Sensitivity and Specificity
• Severity of Illness Index
• Stomach Neoplasms/mortality
• Stomach Neoplasms/surgery
• Treatment Outcome