Artiles-Armas Manuel, Roque-Castellano Cristina, Fariña-Castro Roberto, Conde-Martel Alicia, Acosta-Mérida María Asunción, Marchena-Gómez Joaquín
Department of General Surgery, Hospital Universitario de Gran Canaria Doctor Negrín, Barranco La Ballena s/n, 35012, Las Palmas de Gran Canaria, Spain.
Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
World J Surg Oncol. 2021 Apr 10;19(1):106. doi: 10.1186/s12957-021-02221-6.
Frailty has been shown to be a good predictor of post-operative complications and death in patients undergoing gastrointestinal surgery. The aim of this study was to analyze the differences between frail and non-frail patients undergoing colorectal cancer surgery, as well as the impact of frailty on long-term survival in these patients.
A cohort of 149 patients aged 70 years and older who underwent elective surgery for colorectal cancer was followed-up for at least 5 years. The sample was divided into two groups: frail and non-frail patients. The Canadian Study of Health and Aging-Clinical Frailty Scale (CSHA-CFS) was used to detect frailty. The two groups were compared with regard to demographic data, comorbidities, functional and cognitive statuses, surgical risk, surgical variables, tumor extent, and post-operative outcomes, which were mortality at 30 days, 90 days, and 1 year after the procedure. Univariate and multivariate analyses were also performed to determine which of the predictive variables were related to 5-year survival.
Out of the 149 patients, 96 (64.4%) were men and 53 (35.6%) were women, with a median age of 75 years (IQR 72-80). According to the CSHA-CFS scale, 59 (39.6%) patients were frail, and 90 (60.4%) patients were not frail. Frail patients were significantly older and had more impaired cognitive status, worse functional status, more comorbidities, more operative mortality, and more serious complications than non-frail patients. Comorbidities, as measured by the Charlson Comorbidity Index (p = 0.001); the Lawton-Brody Index (p = 0.011); failure to perform an anastomosis (p = 0.024); nodal involvement (p = 0.005); distant metastases (p < 0.001); high TNM stage (p = 0.004); and anastomosis dehiscence (p = 0.013) were significant univariate predictors of a poor prognosis on univariate analysis. Multivariate analysis of long-term survival, with adjustment for age, frailty, comorbidities and TNM stage, showed that comorbidities (p = 0.002; HR 1.30; 95% CI 1.10-1.54) and TNM stage (p = 0.014; HR 2.06; 95% CI 1.16-3.67) were the only independent risk factors for survival at 5 years.
Frailty is associated with poor short-term post-operative outcomes, but it does not seem to affect long-term survival in older patients with colorectal cancer. Instead, comorbidities and tumor stage are good predictors of long-term survival.
虚弱已被证明是胃肠道手术患者术后并发症和死亡的良好预测指标。本研究的目的是分析接受结直肠癌手术的虚弱患者和非虚弱患者之间的差异，以及虚弱对这些患者长期生存的影响。
对149例年龄在70岁及以上接受择期结直肠癌手术的患者进行了至少5年的随访。样本分为两组：虚弱患者和非虚弱患者。采用加拿大健康与衰老临床虚弱量表（CSHA-CFS）来检测虚弱。比较两组患者的人口统计学数据、合并症、功能和认知状态、手术风险、手术变量、肿瘤范围及术后结局，即术后30天、90天和1年的死亡率。还进行了单因素和多因素分析，以确定哪些预测变量与5年生存率相关。
149例患者中，男性96例（64.4%），女性53例（35.6%），中位年龄为75岁（四分位间距72 - 80岁）。根据CSHA-CFS量表，59例（39.6%）患者虚弱，90例（60.4%）患者非虚弱。与非虚弱患者相比，虚弱患者年龄显著更大，认知状态受损更严重，功能状态更差，合并症更多，手术死亡率更高，并发症更严重。在单因素分析中，用Charlson合并症指数衡量的合并症（p = 0.001）；Lawton-Brody指数（p = 0.011）；未进行吻合术（p = 0.024）；淋巴结受累（p = 0.005）；远处转移（p < 0.001）；高TNM分期（p = 0.004）；以及吻合口裂开（p = 0.013）是预后不良的显著单因素预测指标。在对年龄、虚弱、合并症和TNM分期进行调整的长期生存多因素分析中，显示合并症（p = 0.002；HR 1.30；95%CI 1.10 - 1.54）和TNM分期（p = 0.014；HR 2.06；95%CI 1.16 - 3.67）是5年生存的唯一独立危险因素。
虚弱与术后短期不良结局相关，但似乎不影响老年结直肠癌患者的长期生存。相反，合并症和肿瘤分期是长期生存的良好预测指标。
