Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan.
Int J Clin Oncol. 2024 Jan;29(1):47-54. doi: 10.1007/s10147-023-02429-4. Epub 2023 Nov 9.
With the rapid aging of populations worldwide, the number of vulnerable patients with liver metastasis from colorectal cancer has increased. This study aimed to examine the association between vulnerability and clinical outcomes in patients with colorectal liver metastasis (CRLM).
Consecutive 101 patients undergoing upfront hepatectomy for CRLM between 2004 and 2020 were included. The preoperative vulnerability was assessed using the Clinical Frailty Scale (CFS) score ranging from one (very fit) to nine (terminally ill), and frailty was defined as a CFS score of ≥ 4. A multivariable Cox proportional hazard regression model was utilized to investigate associations of frailty with disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS).
Of the 101 patients, 12 (12%) had frailty. Associations between frailty and surgical outcomes, namely, the incidence of 90-day mortality and postoperative complications, were not statistically significant (P > 0.05). In the multivariable analyses, after adjusting for clinical risk scores calculated using six factors (timing of liver metastasis, primary tumor lymph node status, number of liver tumors, size of the largest tumor, extrahepatic metastatic disease, and carbohydrate antigen 19-9 level) to predict recurrence following hepatectomy for CRLM, preoperative frailty was found to be an independent risk factor for DFS (hazard ratio [HR]:2.37, 95% confidence interval [CI] 1.06-4.72, P = 0.036), OS (HR:4.17, 95% CI 1.43-10.89, P = 0.011), and CSS (HR:3.49, 95% CI 1.09-9.60, P = 0.036).
Preoperative frailty was associated with worse DFS, OS, and CSS after upfront hepatectomy for CRLM. Assessment and improvement of patient vulnerability may provide a favorable prognosis for patients with CRLM.
随着全球人口老龄化的迅速发展，患有结直肠癌肝转移的脆弱患者数量不断增加。本研究旨在探讨结直肠癌肝转移（CRLM）患者脆弱性与临床结局之间的关系。
纳入 2004 年至 2020 年间接受初次肝切除术治疗 CRLM 的连续 101 例患者。使用临床虚弱量表（CFS）评分（范围为 1 分[非常健康]至 9 分[终末期]）评估术前脆弱性，虚弱定义为 CFS 评分≥4 分。使用多变量 Cox 比例风险回归模型研究虚弱与无病生存率（DFS）、总生存率（OS）和癌症特异性生存率（CSS）之间的关联。
101 例患者中，12 例（12%）存在虚弱。虚弱与手术结局（90 天死亡率和术后并发症发生率）之间的关联无统计学意义（P>0.05）。在多变量分析中，在校正了使用 6 个因素（肝转移的时间、原发肿瘤淋巴结状态、肝肿瘤数量、最大肿瘤大小、肝外转移疾病和碳水化合物抗原 19-9 水平）计算的预测 CRLM 肝切除术后复发的临床风险评分后，发现术前虚弱是 DFS（风险比[HR]：2.37，95%置信区间[CI] 1.06-4.72，P=0.036）、OS（HR：4.17，95%CI 1.43-10.89，P=0.011）和 CSS（HR：3.49，95%CI 1.09-9.60，P=0.036）的独立危险因素。
初次肝切除术前的虚弱与 CRLM 患者的 DFS、OS 和 CSS 较差相关。对患者脆弱性的评估和改善可能为 CRLM 患者提供有利的预后。
