Preoperative low prealbumin independently predicts non-gastric cancer death after gastrectomy in elderly and young patients: a retrospective cohort study.

[PURPOSE] To investigate the effect of preoperative prealbumin levels on long-term survival outcomes after gastrectomy in patients with gastric cancer (GC) dichotomized based on age.

[METHODS] This retrospective cohort study included consecutive patients who underwent radical gastrectomy for primary stage I-III GC between May 2006 and March 2017. Patients were allocated to groups based on age (≥ 70 or < 70 years) and subgroups based on prealbumin levels (high, ≥ 22 mg/dL; moderate, 15-22 mg/dL; or low, < 15 mg/dL), and multivariate Cox regression was used for survival analyses.

[RESULTS] Of 4732 patients, 3172 (67.0%) were aged < 70 years and 1560 (33.0%) were ≥ 70 years of age. The median follow-up period was 66 months. A low prealbumin level was an independent prognostic factor for poor overall survival in older patients only [hazard ratio, 2.057; 95% confidence interval, 1.528-2.770; P < 0.001]. A low prealbumin level was an independent prognostic factor for poor other-cause survival in the older (hazard ratio: 2.719, 95% confidence interval: 1.887-3.918, P < 0.001) and younger (HR: 4.611, 95% CI 2.424-8.772, P < 0.001) groups.

[CONCLUSION] Low preoperative prealbumin levels were associated with poor overall survival in older patients with GC after gastrectomy and with earlier non-GC death in older and younger patients.