Tanaka Tsuyoshi, Suda Koichi, Ueno Masaki, Iizuka Toshiro, Uyama Ichiro, Udagawa Harushi
Department of Gastroenterological Surgery, Toranomon Hospital, Minato-ku, Tokyo, Japan.
Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University, Toyoake, Aichi, Japan.
Gen Thorac Cardiovasc Surg. 2022 Jun;70(6):575-583. doi: 10.1007/s11748-022-01807-5. Epub 2022 Mar 25.
We aimed to clarify the association between frailty evaluated using the clinical frailty scale (CFS) and outcomes in elderly patients with esophageal squamous cell carcinoma.
We retrospectively included 67 patients (aged ≥ 75 years) diagnosed with esophageal squamous cell carcinoma (tumor depth ≥ m3) between 2011 and 2016. The patients were retrospectively evaluated and categorized according to their CFS scores (1-7) and divided into non-frailty (scores 1-2) and frailty groups (scores 3-7). Postoperative complications, 5 year survival rate, and prognostic risk factors were analyzed.
Significant differences in performance status, American Society of Anesthesiologists-Physical Status score, Charlson comorbidity index, and treatment type were observed between the two groups. Thirty-six patients underwent surgery, and morbidities with Clavien-Dindo grades ≥ II and ≥ IIIa were found in 72.2 and 47.2% of the patients, respectively. The remaining 31 patients underwent endoscopic resection and/or chemo (radio) therapy. The morbidity rate did not differ between the two groups. The 5 year survival rate was 75.3% overall and 92.7 and 60.8% in patients in the non-frailty and frailty groups, respectively (p = 0.007). Multivariate analysis revealed that frailty and cStage ≥ II were independent risk factors of overall survival (p = 0.005 and p = 0.013, respectively) and disease-specific survival (p = 0.048 and p = 0.027, respectively).
Frailty greatly impacts the prognosis of elderly patients with esophageal cancer, regardless of surgical or nonsurgical treatment. The CFS score could be a useful prognostic predictor.
我们旨在阐明使用临床衰弱量表（CFS）评估的衰弱与老年食管鳞状细胞癌患者预后之间的关联。
我们回顾性纳入了2011年至2016年间诊断为食管鳞状细胞癌（肿瘤深度≥m3）的67例患者（年龄≥75岁）。根据患者的CFS评分（1 - 7分）进行回顾性评估和分类，分为非衰弱组（评分1 - 2分）和衰弱组（评分3 - 7分）。分析术后并发症、5年生存率和预后危险因素。
两组在体能状态、美国麻醉医师协会身体状况评分、Charlson合并症指数和治疗类型方面存在显著差异。36例患者接受了手术，分别有72.2%和47.2%的患者出现Clavien - Dindo分级≥II级和≥IIIa级的并发症。其余31例患者接受了内镜切除和/或化学（放射）治疗。两组的发病率无差异。总体5年生存率为75.3%，非衰弱组和衰弱组患者的5年生存率分别为92.7%和60.8%（p = 0.007）。多因素分析显示，衰弱和cStage≥II是总生存（分别为p = 0.005和p = 0.013）和疾病特异性生存（分别为p = 0.048和p = 0.027）的独立危险因素。
无论手术或非手术治疗，衰弱对老年食管癌患者的预后有很大影响。CFS评分可能是一个有用的预后预测指标。
