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<p>Chronological age is a recognized cancer risk factor but does not capture inter-individual differences in systemic aging. Biological age, reflecting cumulative functional decline, may better predict cancer outcomes. This study examined associations between biological age, disease characteristics, metastasis, and survival in gastrointestinal cancers. Methods: We retrospectively analyzed 3,074 patients. Biological age was estimated from clinical biomarkers, and ΔAge (biological–chronological age) was calculated. Patients were grouped by biological age quartiles. Logistic and Cox regression, Kaplan–Meier, restricted cubic splines, and subgroup/sensitivity analyses were conducted. A prognostic nomogram integrating biological age was developed and validated. Results: Higher biological age correlated with older chronological age, male sex, smoking, systemic inflammation, and lower nutrition. ΔAge was largest in patients &lt; 50&#xa0;years. Biological age was not associated with TNM stage but independently predicted metastasis (per 1-SD: OR = 1.02, 95% CI: 1.01–1.03). The highest quartile nearly doubled metastasis risk, most evident in patients aged 50–64&#xa0;years. During a median 47.9-month follow-up, 951 deaths occurred. Elevated biological age predicted poorer survival (highest vs. second quartile: HR = 2.04, 95% CI: 1.58–2.62), with nonlinear dose–response associations. Prognostic value was stronger in middle-aged and older patients. The nomogram demonstrated good discrimination (C-index 0.687–0.732; AUCs up to 0.846).Conclusions: Biological age, independent of chronological age and TNM stage, is a strong predictor of metastasis and survival in gastrointestinal cancers. ΔAge is greatest in younger individuals, while prognostic impact is most pronounced in middle-aged and older patients. Incorporating biological age may improve risk stratification and individualized management.</p>

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Age-dependent prognostic value of biological age for metastasis and survival in gastrointestinal cancer

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月8日

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  • Jingxian Zheng,
  • Chunhua Song,
  • Hongxia Xu,
  • Zengqing Guo,
  • Wang Kunhua,
  • Fu Zhenming,
  • Wang Chang,
  • Weng Min,
  • Cao Jingjing,
  • Zhou Fuxiang,
  • Lin Yuan,
  • Li Suyi,
  • Ba Yi,
  • Yuan Kaitao,
  • Liu Ming,
  • Hu Wen,
  • Zhou Lan,
  • Ma Hu,
  • Yao Qinghua,
  • Cong Minghua,
  • Li Tao,
  • Chen Zihua,
  • Chen Gongyan,
  • Zhao Qingchuan,
  • Li Zengning,
  • Feng Changyan,
  • He Ying,
  • Wu Jing,
  • Yang Jiajun,
  • Song Xinxia,
  • Yu Yaying,
  • Ma Wenjun,
  • Luo Suxia,
  • Zheng Jin,
  • Chen Junqiang,
  • Luo Qi,
  • Wang Wei,
  • Qiao Qiugé,
  • Shi Yongmei,
  • Qi Yumei,
  • Feng Yongdong,
  • Jiang Haiping,
  • Qiu Hong,
  • Guan Wenxian,
  • Chen Jiaxin,
  • Huang He,
  • Yu Zhen,
  • Fang Yu,
  • Cui Jiuwei,
  • Li Wei,
  • Shi Hanping

摘要

Chronological age is a recognized cancer risk factor but does not capture inter-individual differences in systemic aging. Biological age, reflecting cumulative functional decline, may better predict cancer outcomes. This study examined associations between biological age, disease characteristics, metastasis, and survival in gastrointestinal cancers. Methods: We retrospectively analyzed 3,074 patients. Biological age was estimated from clinical biomarkers, and ΔAge (biological–chronological age) was calculated. Patients were grouped by biological age quartiles. Logistic and Cox regression, Kaplan–Meier, restricted cubic splines, and subgroup/sensitivity analyses were conducted. A prognostic nomogram integrating biological age was developed and validated. Results: Higher biological age correlated with older chronological age, male sex, smoking, systemic inflammation, and lower nutrition. ΔAge was largest in patients < 50 years. Biological age was not associated with TNM stage but independently predicted metastasis (per 1-SD: OR = 1.02, 95% CI: 1.01–1.03). The highest quartile nearly doubled metastasis risk, most evident in patients aged 50–64 years. During a median 47.9-month follow-up, 951 deaths occurred. Elevated biological age predicted poorer survival (highest vs. second quartile: HR = 2.04, 95% CI: 1.58–2.62), with nonlinear dose–response associations. Prognostic value was stronger in middle-aged and older patients. The nomogram demonstrated good discrimination (C-index 0.687–0.732; AUCs up to 0.846).Conclusions: Biological age, independent of chronological age and TNM stage, is a strong predictor of metastasis and survival in gastrointestinal cancers. ΔAge is greatest in younger individuals, while prognostic impact is most pronounced in middle-aged and older patients. Incorporating biological age may improve risk stratification and individualized management.