Prognostic Value and Association of the Age-Adjusted Charlson Comorbidity Index with Sarcopenia Within Patients with Gastric Cancer Following Radical Resection

Purpose: The association between the age-adjusted Charlson Comorbidity Index (ACCI) and sarcopenia in patients with gastric cancer (GC) remains ambiguous. This study aimed to investigate the association between the ACCI and sarcopenia and the prognostic value in patients with GC after radical resection. In addition, this study aimed to develop a novel prognostic scoring system based on these factors. Methods: Univariate and multivariate Cox regression analyses were used to determine prognostic factors in patients undergoing radical GC resection. Based on the ACCI and sarcopenia, a new prognostic score (age adjusted Charlson Comorbidity Index and Sarcopenia [ACCIS]) was established, and its prognostic value was assessed. Results: This study included 1068 patients with GC. Multivariate analysis revealed that the ACCI and sarcopenia were independent risk factors during the prognosis of GC (P = 0.001 and P < 0.001, respectively). A higher ACCI score independently predicted sarcopenia (P = 0.014). A high ACCIS score was associated with a greater American Society of Anesthesiologists score, higher pathologic TNM (pTNM) stage, and larger tumor size (all P < 0.05). Multivariate analysis demonstrated that the ACCIS independently predicted the prognosis for patients with GC (P < 0.001). By incorporating the ACCIS score into a prognostic model with sex, pTNM stage, tumor size, and tumor differentiation, we constructed a nomogram to predict the prognosis accurately (concordance index of 0.741). Conclusion: The ACCI score and sarcopenia are significantly correlated in patients with GC. The integration of the ACCI score and sarcopenia markedly enhances the accuracy of prognostic predictions in patients with GC. (c) 2024 Society for Surgery of the Alimentary Tract. Published by Elsevier Inc. All rights reserved.