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

Table 1 Comparison of baseline characteristics between the two groups, n (%)

Group	n	Age (year), mean ± SD	Gender		Tumor type					ECOG grade (point)
			Male	Female	Colorectal cancer	Gastric cancer	Esophageal cancer	Liver cancer	Pancreatic cancer
Observation group	102	76.5 ± 4.8	59 (57.8)	43 (42.2)	46 (45.1)	28 (27.5)	10 (9.8)	12 (11.1)	6 (5.9)	1.2 ± 0.5
Control group	108	77.1 ± 5.2	65 (60.2)	43 (39.8)	48 (44.4)	32 (29.6)	12 (11.1)	10 (9.8)	6 (5.6)	1.1 ± 0.4
χ2/t value	-	0.851	0.102		1.234					1.666
P value	-	0.396	0.749		0.872					0.107

ECOG: Eastern Cooperative Oncology Group.

Table 2 Comprehensive geriatric assessment dimension assessment tools, abnormality criteria, and general intervention measures

CGA assessment dimensions	Assessment tool/method	Abnormality threshold	General interventions
Comorbidities	CCI	CCI ≥ 2	Refer to geriatrics or relevant specialty; optimize comorbidity management
Functional status	Activities of Daily Living scale	Total score < 100	Refer to rehabilitation medicine; devise a rehab plan; arrange home-care services
Nutritional status	MNA-SF	≤ 11 points	Refer to clinical nutrition; provide dietary counseling, oral nutritional supplements or mandatory nutritional support
Cognitive function	MMSE	Illiterate ≤ 17; primary-school ≤ 20; middle-school ≤ 24	Enhance communication with primary caregiver; remind and supervise medication; schedule cognitive training
Psychological status	GDS-15	≥ 5 points	Refer to psychiatry/psychology; provide psychological counseling; strengthen family emotional support
Frailty status	CFS	Grade ≥ 4	Use as core input for MDT decisions; initiate comprehensive nutrition, rehabilitation and supportive care
Polypharmacy	Medication list review	Concurrent use of ≥ 5 drugs	Clinical pharmacist or geriatrician conducts medication reconciliation; discontinue non-essential or inappropriate drugs
Social support	Structured interview	Living alone/no stable caregiver/financial hardship	Social-worker intervention; assist with subsidy applications; link to community support services

CGA: Comprehensive geriatric assessment; CCI: Charlson comorbidity index; MNA-SF: Mini Nutritional Assessment-Short Form; MMSE: Mini-Mental State Examination; GDS-15: Geriatric Depression Scale-15; CFS: Clinical Frailty Scale; MDT: Multidisciplinary team.

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.

Table 4 Comparison of treatment decisions and intensity between the two groups, n (%)

Group	n	Initial treatment strategy			Treatment intensity
		Standard treatment	Palliative therapy	Supportive care only	Normal intensity	Reduced intensity	Low intensity
Observation group	102	35 (35.3)	48 (46.1)	19 (18.6)	42 (41.2)	48 (47.1)	12 (11.8)
Control group	108	53 (48.1)	38 (36.1)	17 (15.7)	65 (60.2)	32 (29.6)	11 (10.2)
χ2/t value	-	4.427	2.686	0.332	7.699	6.941	0.139
P value	-	0.035	0.101	0.564	0.006	0.008	0.709

Table 5 Comparison of treatment safety between the two groups, n (%)

Group	n	Neutropenia	Thrombocytopenia	Diarrhea	Neurotoxicity	Overall grade ≥ 3 adverse events
Observation group	102	12 (11.8)	8 (7.8)	5 (4.9)	4 (3.9)	29 (28.4)
Control group	108	25 (23.1)	15 (13.9)	11 (10.2)	8 (7.4)	49 (45.4)
χ2/t value	-	-	-	-	-	6.834
P value	-	-	-	-	-	0.009

Table 6 Comparison of treatment tolerability between the two groups, n (%)

Group	n	Treatment delay	Treatment discontinuation	Treatment completion
Observation group	102	21 (20.6)	12 (11.8)	90 (88.2)
Control group	108	35 (32.4)	26 (24.1)	82 (75.9)
χ2/t value	-	3.945	5.678	5.512
P value	-	0.047	0.017	0.019

Table 7 Multivariate Cox regression analysis of progression-free survival in both groups

Variable	HR	95%CI	P value
Age (per five-year increase)	1.32	1.05-1.66	0.018
ECOG score (≥ 2 vs < 2)	1.87	1.24-2.82	0.003
TNM stage (stage IV vs I-III)	2.45	1.65-3.64	< 0.001
Comprehensive geriatric assessment category (ref = control group)	-	-	0.028
Fit	0.65	0.42-1.01	0.055
Vulnerable	0.71	0.50-0.99	0.046
Frail	1.05	0.62-1.78	0.856

CI: Confidence interval; HR: Hazard ratio; ECOG: Eastern Cooperative Oncology Group; TNM: Tumor-node-metastasis.