Shao Yu-Fei, Zu Ya-Nan, Yin Xiang-Qi, Xiao Jin-Chang, Gu Yu-Ming
Department of Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China.
Department of General Practice, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, China.
Sci Rep. 2025 Apr 13;15(1):12746. doi: 10.1038/s41598-025-98043-7.
Transcatheter arterial chemoembolization (TACE) is a standard treatment for unresectable, intermediate, or advanced-stage hepatocellular carcinoma (HCC), especially in elderly patients. The modified 5-item frailty index (mFI-5) is a concise, comorbidity-based risk stratification tool proven to effectively predict adverse outcomes. However, the prognostic capacity of the mFI-5 in elderly HCC patients after TACE is unclear. As such, we retrospectively analyzed clinical data from elderly HCC patients (age ≥ 65 years) who received their first TACE between November 2018 and November 2020 at the Department of Interventional Radiology, Affiliated Hospital of Xuzhou Medical University. The mFI-5 was calculated based on the presence of five co-morbidities: congestive heart failure within 30 days prior to surgery; insulin-dependent or noninsulin-dependent diabetes mellitus; chronic obstructive pulmonary disease (COPD) or pneumonia; partially dependent or totally dependent functional health status at time of surgery; and hypertension requiring medication. Patients were divided into two groups based on mFI-5 scores: mFI-5 ≥ 2 ('frail') and mFI-5 < 2 ('non-frail'). The primary outcomes were overall survival (OS) and progression-free survival (PFS).Among the 143 patients, 97 were in the mFI-5 < 2 group and 46 in the mFI-5 ≥ 2 group. The median OS was 40.0 months (95% confidence interval [CI]: 35.0-47.0) in the non-frail group vs. 24.0 months (95% CI: 22-NA) in the frail group (hazard ratio [HR] = 3.343, 95% CI: 1.802-6.201, p < .001). The median PFS was 7.0 months (95% CI: 4.0-11.0) vs. 3.0 months (95% CI: 2.0-9.0) (HR = 1.507, 95% CI: 0.996-2.280, p = .053). Cox regression identified mFI-5, alpha-fetoprotein (AFP) as independent predictors of OS. The mFI-5 is a useful predictor of long-term survival in elderly HCC patients treated with TACE, suggesting that incorporating frailty assessments can optimize treatment strategies and improve outcomes.
经动脉化疗栓塞术（TACE）是不可切除的中期或晚期肝细胞癌（HCC）的标准治疗方法，尤其适用于老年患者。改良的5项衰弱指数（mFI-5）是一种基于合并症的简明风险分层工具，已被证明能有效预测不良预后。然而，mFI-5对老年HCC患者TACE术后的预后评估能力尚不清楚。因此，我们回顾性分析了2018年11月至2020年11月在徐州医科大学附属医院介入放射科接受首次TACE治疗的老年HCC患者（年龄≥65岁）的临床资料。mFI-5根据以下五种合并症计算：术前30天内的充血性心力衰竭；胰岛素依赖型或非胰岛素依赖型糖尿病；慢性阻塞性肺疾病（COPD）或肺炎；手术时部分依赖或完全依赖的功能健康状态；以及需要药物治疗的高血压。根据mFI-5评分将患者分为两组：mFI-5≥2（“衰弱”）和mFI-5＜2（“非衰弱”）。主要结局为总生存期（OS）和无进展生存期（PFS）。
在143例患者中，mFI-5＜2组97例，mFI-5≥2组46例。非衰弱组的中位OS为40.0个月（95%置信区间[CI]：35.0-47.0），而衰弱组为24.0个月（95%CI：22-无可用数据）（风险比[HR]=3.343，95%CI：1.802-6.201，p＜0.001）。中位PFS分别为7.0个月（95%CI：4.0-11.0）和3.0个月（95%CI：2.0-9.0）（HR=1.507，95%CI：0.996-2.280，p=0.053）。Cox回归分析确定mFI-5、甲胎蛋白（AFP）是OS的独立预测因素。mFI-5是接受TACE治疗的老年HCC患者长期生存的有用预测指标，这表明纳入衰弱评估可以优化治疗策略并改善预后。
