Spotting the vulnerable: Preoperative risk stratification in non-metastatic colorectal cancer patients aged 80 years and older.

Authors

Hsin-Yi Liu, Chi-Ling Chen, Jin-Tung Liang, John Huang, Ji-Shiang Hung, Tzu-Chun Chen, Been-Ren Lin

Published in

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology. Volume 52. Issue 12. Pages 112156. Sep 16, 2026. Epub Sep 16, 2026.

Abstract

While colorectal cancer (CRC) surgery is well established in the broader older population, patients aged ≥ 80 years experience a steep rise in frailty, functional dependency, and failure-to-rescue rates. Identifying simple, clinically relevant preoperative indicators may improve risk stratification and guide patient-centered surgical decision-making.
We retrospectively analyzed 449 patients aged ≥80 years who underwent curative surgery for non-metastatic CRC. Barthel Index (BI) and body mass index (BMI) were evaluated as predictors of one-year mortality. A prognostic nomogram incorporating age, BI, and BMI was constructed. Patients were stratified into low-, medium-, and high-risk groups based on model scores. Performance of the nomogram was assessed with discrimination, calibration, and decision curve analysis.
Overall 1-year mortality was 11.6% (n = 52). BI (OR: 0.963, p < 0.001) and BMI (OR: 0.877, p = 0.023) emerged as independent predictors. The nomogram achieved an AUC of 0.746 in the derivation cohort and 0.724 in the validation cohort. High-risk patients exhibited significantly higher major complication rates (17.9% vs. 4.1%, p < 0.001), higher 1-year mortality (22.7% vs. 5.3%, p < 0.001), and inferior overall survival (adjusted HR: 2.112, 95% CI: 1.480-3.013, p < 0.001) compared with low-risk patients.
A nomogram combining age, BI and BMI reliably stratifies postoperative vulnerability and 1-year mortality in patients aged ≥80 years, supporting targeted prehabilitation and surgical shared decision-making.

PMID:
42759441
Bibliographic data and abstract were imported from PubMed on 19 Sep 2026.

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