P1.236. Surgical Decision Model for Elderly Patients With Esophageal Cancer: Development and Validation of a Geriatric Stage (gStage) System

Abstract

Abstract Topic Esophageal Cancer: Surgical Treatment of Esophageal Cancer – long term outcomes Background The increasing age of patients with esophageal cancer poses significant challenges in surgical decision-making. Elderly individuals frequently present with multimorbidity, impaired physiological reserve, and nutritional vulnerability, all of which increase postoperative risk. Chronological age and performance status alone are insufficient to determine surgical eligibility. A structured approach incorporating multidimensional geriatric assessment may allow more appropriate stratification of surgical intensity. Methods To establish a frailty-integrated framework for surgical treatment selection in elderly patients with esophageal cancer and to evaluate the prognostic performance of a novel classification combining frailty and tumor stage. This retrospective study included 138 elderly patients who underwent Comprehensive Geriatric Assessment (CGA) between September 2015 and December 2024. Patients were categorized as Fit, Prefrail, or Frail according to CGA findings. Differences in baseline characteristics and selected treatment strategies were analyzed. To refine risk stratification, we developed a composite index, termed the geriatric Stage (gStage), integrating frailty status with clinical stage (cStage). Overall survival (OS) was assessed across groups. Results The median age was 77 years (range 60–94). Fifty-two patients (37.6%) were classified as Fit, 52 (37.6%) as Prefrail, and 34 (24.6%) as Frail. While age and cStage distribution were comparable among groups, the Frail cohort demonstrated significantly worse ECOG performance status, lower G8 scores, hypoalbuminemia, and lower BMI (all P<0.001). Following CGA evaluation, the proportion of patients considered for standard curative-intent therapy declined progressively according to frailty severity (Fit 67%→58%, Prefrail 65%→42%, Frail 51%→11%; P<0.001). Conversely, the selection of non-surgical or supportive approaches increased markedly in Frail patients (13%→59%). The proposed gStage system demonstrated clear prognostic discrimination. Patients classified as gStage 1 showed the most favorable survival, with stepwise deterioration observed from gStage 2 to 4 (P<0.001 for trend). Conclusion Integrating frailty assessment into surgical planning significantly altered treatment allocation in elderly patients with esophageal cancer. The gStage system, combining physiological vulnerability with tumor burden, provided robust prognostic stratification. This frailty-integrated decision model may support rational tailoring of surgical aggressiveness and optimize treatment balance between oncologic benefit and operative risk in the aging population.