Chambers Laura M, Chalif Julia, Yao Meng, Chichura Anna, Morton Molly, Gruner Morgan, Costales Anthony B, Horowitz Max, Chau Danielle B, Vargas Roberto, Rose Peter G, Michener Chad M, Debernardo Robert
Division of Gynecologic Oncology, Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States.
Obstetrics, Gynecology, Women's Health Institute, Cleveland Clinic, Desk A81, 9500 Euclid Avenue, Cleveland, OH 44195, United States.
Gynecol Oncol. 2021 Aug;162(2):368-374. doi: 10.1016/j.ygyno.2021.05.013. Epub 2021 May 31.
OBJECTIVE(S): To evaluate the impact of frailty on postoperative complications following cytoreductive surgery (CRS) with hyperthermic intra-peritoneal chemotherapy (HIPEC) in women with advanced or recurrent gynecologic cancer.
An IRB-approved single-institution prospective registry was queried for women who underwent CRS with HIPEC for advanced or recurrent gynecologic cancer from 1/1/2014-12/31/2020. Frailty was defined as a modified Frailty Index (mFI) score of ≥2. Logistic regression was used to assess the impact of mFI upon the rate of moderate or higher (≥ grade 2) Accordion postoperative complications.
Of 141 women, 81.6% (n = 115) were non-frail with mFI of 0-1 and 18.4% (n = 26) were frail with mFI ≥2. The incidence of ≥ grade 2 complications was 21.2% (n = 14) for mFI = 0, 26.5% (n = 13) for mFI = 1, 64.7% (n = 11) for mFI = 2 and 100.0% (n = 9) for patients with mFI ≥3. The incidence of re-operation (1.7% vs. 11.5%, p = 0.044), ICU admission (13.2% vs. 34.6%, p = 0.018), acute kidney injury (6.3% vs. 30.8%, p = 0.001), and respiratory failure (0.9% vs. 19.2%, p < 0.001) were significantly lower amongst non-frail vs. frail women. On multivariable analysis, mFI ≥2 was associated with significantly increased ≥ grade 2 complications versus mFI of 0-1 (OR 9.4, 95% CI 3.3, 26.4, p < 0.001). Age (OR 1.04, 95% CI 1.00, 1.09, p = 0.07), surgical indication (recurrent vs. primary) (OR 0.71, 95% CI 0.30, 1.7, p = 0.44) and Surgical Complexity Score of Intermediate or High vs. Low (OR 1.5, 95% CI 0.67, 3.5, p = 0.31) were not associated with ≥grade 2 complications.
Frailty, defined by the modified frailty index, is predictive of ≥grade 2 postoperative complications following CRS with HIPEC in women with gynecologic cancer. Frailty screening before CRS with HIPEC may assist patient selection and improve postoperative outcomes.
评估虚弱对晚期或复发性妇科癌症女性患者接受细胞减灭术（CRS）联合热灌注化疗（HIPEC）后术后并发症的影响。
查询一个经机构审查委员会（IRB）批准的单机构前瞻性登记处，纳入2014年1月1日至2020年12月31日期间因晚期或复发性妇科癌症接受CRS联合HIPEC的女性患者。虚弱定义为改良虚弱指数（mFI）评分≥2。采用逻辑回归分析评估mFI对中度或更严重（≥2级）手风琴术后并发症发生率的影响。
141名女性患者中，81.6%（n = 115）为非虚弱患者，mFI为0 - 1；18.4%（n = 26）为虚弱患者，mFI≥2。mFI = 0时，≥2级并发症的发生率为21.2%（n = 14）；mFI = 1时为26.5%（n = 13）；mFI = 2时为64.7%（n = 11）；mFI≥3的患者为100.0%（n = 9）。非虚弱女性与虚弱女性相比，再次手术发生率（1.7%对11.5%，p = 0.044）、入住重症监护病房（ICU）发生率（13.2%对34.6%，p = 0.018）、急性肾损伤发生率（6.3%对30.8%，p = 0.001）和呼吸衰竭发生率（0.9%对19.2%，p < 0.001）显著更低。多变量分析显示，与mFI为0 - 1相比，mFI≥2与≥2级并发症显著增加相关（比值比[OR] 9.4，95%置信区间[CI] 3.3，26.4，p < 0.001）。年龄（OR 1.04，95% CI 1.00，1.09，p = 0.07）、手术指征（复发与原发）（OR 0.71，95% CI 0.30，1.7，p = 0.44）以及手术复杂程度评分中高与低（OR 1.5，95% CI 0.67，3.5，p = 0.31）与≥2级并发症无关。
改良虚弱指数定义的虚弱可预测妇科癌症女性患者接受CRS联合HIPEC后≥2级术后并发症。在CRS联合HIPEC前进行虚弱筛查可能有助于患者选择并改善术后结局。
