Glasgow Prognostic Score and Outcomes in Elderly Head and Neck Cancer Surgery With Free-Flap Reconstruction: A Retrospective Study

Background Determining good candidates for head and neck cancer surgery in elderly patients requires consideration of various factors, such as overall health and social background, yet specific evaluation guidelines are lacking. The Glasgow Prognostic Score (GPS) is a marker used to assess nutritional status and prognosis in cancer patients. Objective This study aims to evaluate the association between the GPS and both the prognosis and postoperative complications in reconstructive surgery cases for head and neck cancer in patients aged 80 and over. Materials and methods A total of 22 patients aged 80 and over who underwent reconstructive surgery in our department between January 2011 and December 2023 were included. Patients were divided into three groups based on their preoperative GPS scores (0, 1, and 2 points). The overall survival was evaluated using the Kaplan-Meier method. The Cox proportional hazards model was used to analyze the association between GPS and prognosis, adjusting for confounders such as malnutrition, primary site, and comorbidities. The association between GPS and perioperative complications classified as Clavien-Dindo grade 3 or higher was also examined. Results The mean age was 82.2 years, and 20 (90%) of the subjects had comorbidities. Higher GPS scores were associated with lower survival rates, and GPS was an independent prognostic factor. There was no significant association between GPS and perioperative complications of grade 3 or higher. Conclusion The GPS is a useful prognostic indicator in elderly patients undergoing reconstructive surgery for head and neck cancer. However, a comprehensive evaluation such as the Geriatric 8, along with more inclusive malnutrition criteria, is recommended for an overall assessment of good candidates for the procedure.