虚弱排斥手术：虚弱指数对手术干预和结果的影响。
Frailty repels the knife: The impact of frailty index on surgical intervention and outcomes.
机构信息
Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States of America; Division of Gynecologic Oncology, Department of Obstetrics & Gynecology, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, United States of America; H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States of America.
Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States of America.
出版信息
Gynecol Oncol. 2022 Jul;166(1):50-56. doi: 10.1016/j.ygyno.2022.05.009. Epub 2022 May 20.
OBJECTIVE
To assess the impact of frailty in patients with ovarian cancer on surgical procedures and outcomes.
METHODS
A retrospective review of patients with stage II-IV ovarian cancer from April 2013 to September 2017 was performed. Patients were triaged by laparoscopy to determine primary resectability. The adjusted modified frailty index score (amFI) was calculated and amFI ≥2 classified as high frailty. Clinical outcomes, progression free survival (PFS) and overall survival (OS) were estimated.
RESULTS
592 patients met inclusion criteria; amFI of 0, 1 and ≥ 2 was noted in 57%, 29%, and 14%, respectively. Patients with high frailty were less likely to be offered laparoscopic assessment for primary surgery (49% v. 43% v. 28% for amFI = 0, 1, and ≥ 2, p = 0.004), and more likely to have a Fagotti score ≥ 8 (58%, 48%, and 34%, p = 0.04). Only 17% of the high frailty cohort had primary tumor reductive surgery compared to 26% and 34% in patients with amFI = 1 and amFI = 0 (p = 0.02). Furthermore, patients with higher amFI were less likely to undergo any tumor reductive surgery (85% v. 74% v. 59%, p < 0.001). Postoperative complications were more frequent in patients with higher amFI (44% v. 56% v. 64%, p = 0.01). Death within thirty days of treatment initiation was significantly higher in patients with high frailty (0.4% v. 2% v. 9%, p = 0.005). In multivariate analysis, high frailty was associated with worse PFS (p = 0.02) and OS (p < 0.05).
CONCLUSIONS
Postoperative morbidity, PFS, and OS were worse in patients with high frailty scores. Quantification of frailty may be useful for clinical decision making in patients with newly diagnosed advanced ovarian cancer.
目的
评估卵巢癌患者虚弱对手术程序和结果的影响。
方法
对 2013 年 4 月至 2017 年 9 月期间的 II-IV 期卵巢癌患者进行回顾性分析。通过腹腔镜检查对患者进行分类，以确定原发性可切除性。计算调整后的改良虚弱指数评分（amFI），并将 amFI≥2 定义为高度虚弱。评估临床结局、无进展生存期（PFS）和总生存期（OS）。
结果
592 名患者符合纳入标准；amFI 为 0、1 和≥2 的患者分别占 57%、29%和 14%。虚弱程度较高的患者接受腹腔镜评估以进行原发性手术的可能性较低（amFI=0、1 和≥2 的患者分别为 49%、43%和 28%，p=0.004），Fagotti 评分≥8 的可能性较高（58%、48%和 34%，p=0.04）。只有 17%的高度虚弱组患者接受了原发性肿瘤减瘤手术，而 amFI=1 和 amFI=0 的患者分别为 26%和 34%（p=0.02）。此外，amFI 较高的患者接受任何肿瘤减瘤手术的可能性较低（85%、74%和 59%，p<0.001）。amFI 较高的患者术后并发症更为常见（44%、56%和 64%，p=0.01）。在治疗开始后 30 天内死亡的患者中，高度虚弱的患者比例显著更高（0.4%、2%和 9%，p=0.005）。多变量分析显示，高度虚弱与较差的 PFS（p=0.02）和 OS（p<0.05）相关。
结论
虚弱程度较高的患者术后发病率、PFS 和 OS 更差。虚弱程度的量化可能对新诊断的晚期卵巢癌患者的临床决策有用。
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