A Prognostic Nomogram for Elderly Patients with Advanced Gastric Cancer: A Retrospective Study

Objective Gastric cancer (GC), often diagnosed at an advanced stage, predominantly affects elderly individuals. This study aimed to analyze the clinicopathological features and prognostic factors in elderly patients with advanced gastric cancer (AGC) and to construct a nomogram for individualized survival prediction. Methods We retrospectively analyzed data from 428 patients with advanced gastric or gastroesophageal junction (G/GEJ) adenocarcinoma who received first-line chemo-immunotherapy at JiangSu Province Hospital between June 2019 and July 2024. Patients were categorized into elderly (> 65 years) and younger (≤ 65 years) groups based on age. Clinicopathological features and survival outcomes were assessed through medical record reviews and follow-up examinations. Overall survival (OS) and progression-free survival (PFS) were analyzed using Kaplan-Meier methods, and univariate and multivariate Cox regression analyzes were performed to evaluate the impact of clinical characteristics on OS in elderly patients with AGC. Results The study included 222 elderly (> 65 years) and 206 younger (≤ 65 years) AGC patients. Significant differences (P < 0.05) in baseline characteristics were observed between the two age groups regarding body mass index (BMI), Eastern Cooperative Oncology Group Performance Status(ECOG PS), Lauren classification, presence of peritoneal metastases, primary tumor site, tumor differentiation, hemoglobin, leukocyte count, and albumin levels. The median PFS was significantly longer in the elderly group (341 days) than in the younger group (282 days) (P = 0.021). However, no significant difference was observed in median OS between the two groups (584 vs. 596 days, P = 0.405). In elderly patients with AGC, univariate analysis identified ECOG PS, human epidermal growth factor receptor 2 (HER2) status, peritoneal metastases, Lauren classification, tumor differentiation, albumin, Carbohydrate Antigen 19 − 9 (CA19-9), and Carbohydrate Antigen 72 − 4 (CA72-4) as significant prognostic factors; multivariate analysis further established ECOG PS, HER2 status, tumor differentiation, Lauren classification, and albumin as independent prognostic factors for OS. Conclusion ECOG PS, HER2 status, tumor differentiation, Lauren classification, and serum albumin level were identified as independent prognostic factors in elderly patients with AGC. Based on these findings, nutritional intervention emerges as a promising therapeutic target to improve survival outcomes in this population.