Frailty Can Predict Prognosis After Hepatectomy in Patients With Colorectal Liver Metastasis

Abstract

Background/Aim: The aim of this study was to investigate frailty as a prognostic factor in patients with colorectal liver metastasis undergoing hepatectomy. Patients and Methods: Eighty-seven patients who underwent hepatectomy at our institution were enrolled. Frailty was defined as a score of ≥4 on a clinical frailty scale. Patients were divided into frailty (n=29) and non-frailty (n=58) groups. Results: Overall and cancer-specific survival rates were significantly worse in the frailty group compared with the nonfrailty group, and multivariate analysis revealed frailty as an independent prognostic factor. Disease-free survival tended to be worse in the frailty group. Fifty-eight patients relapsed after the first hepatectomy. Twenty-one of 58 recurrent patients were allocated to the frailty group. After recurrence, chemotherapy was significantly more frequently performed in the non-frailty group compared with the frailty group. Conclusion: Frailty can predict the prognosis of patients with colorectal liver metastasis undergoing hepatectomy.Survival in patients with colorectal cancer (CRC) has improved over the last decades, primarily due to efforts in screening and early detection, and the recent advances in systemic and local therapies. However, the main cause of mortality in CRC patients is metastasis. The liver is the most common anatomic site for CRC metastasis (1). Approximately 35%-55% of CRC patients have liver metastases as the disease progresses (2). Surgical resection is currently the treatment of choice for CRC liver metastases, and has been proven as the only curative treatment (3, 4).Due to aging, the number of elderly patients with colorectal liver metastasis (CRLM) will increase significantly in the near future. Age-related complications, such as cardiopulmonary complications, delirium, transfer to a rehabilitation facility, and dependency are major problems after hepatectomy in the elderly patients (5). Given the increasing number of elderly patients with comorbidities undergoing surgery, there is increased interest in preoperatively identifying patients who are at high risk of morbidity and mortality after hepatectomy (6). Frailty is a multidimensional and heterogeneous syndrome associated with instability that differs from disability or aging alone (7). Frailty is commonly measured using summative impairment lists and algorithms based on clinical assessment (8-10). Frailty is very important in predicting surgical outcomes in elderly patients (10). Recently, McIsaac et al. suggested that the clinical frailty scale (CFS) could be used to predict new disability or death after elective noncardiac surgery (11). The CFS is a nine-point global frailty scale based on a clinical evaluation in the domains of mobility, energy, physical activity, and function (12,13). The CFS is a highly acceptable, feasible, and convenient instrument for clinical perioperative use.There have been several reports on the relationship between hepatectomy and frailty (5,6,(14)(15)(16)(17)(18). Louwers et al. (14) reported th...

Usefulness of frailty to predict short‐ and long‐term outcomes in patients who have undergone major hepatectomy for perihilar cholangiocarcinoma

“…The OS of the CFS score 1-2 group was significantly higher than that of the CFS score 3-7 group (P = .01). CFS, Clinical Frailty Scale; OS, overall survival cutoff value of CFS varied among studies, 4,5,11,16 and even in this study, there is a difference in cutoffs for predicting prognosis and the development of complications. This may be due to differences in the impact of frailty on clinical outcomes, and we consider that a different cutoff value for each outcome may allow for a more rigorous evaluation.…”

“…Although the CFS is a semiquantitative scale that does not include preoperative test results, it provides a more detailed assessment, including cognitive function, than the ECOG‐PS, and various studies have reported an association between CFS and clinical outcomes 4,5,11,16,28 . The cutoff value of CFS varied among studies, 4,5,11,16 and even in this study, there is a difference in cutoffs for predicting prognosis and the development of complications. This may be due to differences in the impact of frailty on clinical outcomes, and we consider that a different cutoff value for each outcome may allow for a more rigorous evaluation.…”

“…Several studies have revealed the association between poor outcomes and high frailty scores in patients with various disorders, such as cardiovascular diseases, 24 infectious diseases, 25 liver disease, 26 or malignant diseases including gastrointestinal cancer. 4 , 5 , 6 , 7 , 8 , 27 As for hepatic resection, 11 studies 5 , 6 , 7 , 8 , 9 , 10 , 11 , 13 , 14 , 15 , 16 are available to date, among which 10 showed the usefulness of frailty scoring in predicting mortality, morbidity, or prognosis after hepatectomy. Tanaka et al 7 conducted a prospective multicenter study using the Kihon checklist and demonstrated that high frailty was an independent risk factor for age‐related events (major respiratory complications, major cardiac events, delirium requiring medication, transfer to rehabilitation facility, and dependency).…”

“…Louwers et al 9 and Okabe et al 11 revealed a significant association between frailty and postoperative complications of CD grade III/IV. Moreover, Yamada et al 7 and Tokuda et al 16 described the usefulness of frailty assessed by CFS to estimate the prognosis of hepatocellular carcinoma (HCC) or colorectal liver metastasis after hepatectomy. Although Milliken et al 8 reported no significant difference with the degree of frailty in short‐ and long‐term outcomes after hepatectomy, it is reasonable to suggest—based on the findings of other previous studies—that frailty serves some degree of influence on outcomes after hepatectomy.…”

“…Therefore, it is generally not offered to the elderly population. 1 , 12 , 13 , 14 , 15 , 16 Several studies have evaluated surgery for PHCC in elderly patients. 1 , 12 Although these reports revealed that the rate of postoperative complications and long‐term survival were not significantly different between elderly and younger patients, a less invasive surgical procedure was more frequently selected in elderly patients.…”