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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 1/2021

01-01-2021 | Hepatocellular Carcinoma | Hepatobiliary Tumors

Significance of Frailty in Prognosis After Hepatectomy for Elderly Patients with Hepatocellular Carcinoma

Authors: Shinichiro Yamada, MD, PhD, FACS, Mitsuo Shimada, MD, PhD, FACS, Yuji Morine, MD, PhD, FACS, Satoru Imura, MD, PhD, FACS, Tetsuya Ikemoto, MD, PhD, FACS, Yusuke Arakawa, MD, PhD, FACS, Yu Saito, MD, PhD, FACS, Masato Yoshikawa, MD, PhD, Katsuki Miyazaki, MD

Published in: Annals of Surgical Oncology | Issue 1/2021

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Abstract

Background

The concept of frailty becomes important for patients who undergo surgery in this recent aging society. The aim of this study is to investigate the frailty as a prognostic factor in elderly patients with hepatocellular carcinoma (HCC) who underwent hepatectomy.

Patients and Methods

A total of 92 patients over 75 years old who underwent hepatectomy were enrolled in this study. Frailty was defined as clinical frailty scale (CFS) ≥ 4. Patients were divided into two groups, i.e., frailty group (n = 21) and no-frailty group (n = 71), and clinicopathological features were compared between them.

Results

The frailty group showed significant higher PIVKA-II level and larger tumor diameter (p < 0.05). CRP level and modified Glasgow prognostic score were significantly higher in the frailty group (p < 0.05). The frailty group showed higher rate of postoperative complications of Clavien–Dindo III (p = 0.06) and longer postoperative stay (p = 0.08). Cancer-specific, overall, and disease-free survival rates were significantly worse in the frailty group (p < 0.05). Frailty was detected as an independent prognostic factor on multivariate analysis of cancer-specific survival.

Conclusion

Frailty can estimate the prognosis of HCC patients who underwent hepatectomy.
Literature
1.
Kaibori M, Matsui K, Ishizaki M, et al. Hepatic resection in the elderly. J Surg Oncol. 2009;99:154–160.CrossRef
2.
Yamada S, Shimada M, Miyake H, Utsunomiya T, Morine Y, Imura S, Ikemoto T, Mori H, Hanaoka J, Iwahashi S, Saito Y. Outcome of hepatectomy in super-elderly patients with hepatocellular carcinoma. Hepatol Res. 2012;42:454–8.CrossRef
3.
Hogan DB, MacKnight C, Bergman H, et al. Models, definitions, and criteria of frailty. Aging Clin Exp Res. 2003;15(3 Suppl):1–29.PubMed
4.
Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ (Can Med Assoc J). 2005;173:489–95.CrossRef
5.
Rolfson DB, Majumdar SR, Tsuyuki RT, et al. Validity and reliability of the edmonton frail scale. Age Ageing. 2006;35:526–9.CrossRef
6.
Makary MA, Segev DL, Pronovost PJ, et al. Frailty as a predictor of surgical outcomes in older patients. J Am Coll Surg. 2010;210:901–8.CrossRef
7.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:146–56.CrossRef
8.
Ensrud KE, Ewing SK, Taylor BC, Fink HA, Cawthon PM, Stone KL, et al. Comparison of 2 frailty indexes for prediction of falls, disability, fractures, and death in older women. Arch Intern Med. 2008;168:382–9.CrossRef
9.
Morley JE, Malmstrom TK, Miller DK. A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans. J Nutr Health Aging. 2012;16:601–8.CrossRef
10.
Chow WB, Rosenthal R, Merkow RP, et al. Optimal preoperative assessment of the geriatric surgical patient: a best practices guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society. J Am Coll Surg. 2012;215:453–66.CrossRef
11.
12.
Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173:489–95.CrossRef
13.
Minagawa M, Ikai I, Matsuyama Y, Yamaoka Y, Makuuchi M. Staging of hepatocellular carcinoma: assessment of the Japanese TNM and AJCC/UICC TNM systems in a cohort of 13,772 patients in Japan. Ann Surg. 2007;245:909–922.CrossRef
14.
Kayadibi H, Sertoglu E, Uyanik M, Tapan S. Neutrophil-lymphocyte ratio is useful for the prognosis of patients with hepatocellular carcinoma. World J Gastroenterol. 2014;20:9631–2.CrossRef
15.
Pinato DJ, North BV, Sharma R. A novel, externally validated inflammation-based prognostic algorithm in hepatocellular carcinoma: the prognostic nutritional index (PNI). Br J Cancer. 2012;106:1439–45.CrossRef
16.
Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi. 1984;85:1001–5.PubMed
17.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRef
18.
Rockwood K, Mitnitski A, Song X, Steen B, Skoog I. Long-term risks of death and institutionalization of elderly people in relation to deficit accumulation at age 70. J Am Geriatr Soc. 2006;54:975–79.CrossRef
19.
Clough-Gorr KM, Thwin SS, Stuck AE, Silliman RA. Examining five- and ten-year survival in older women with breast cancer using cancer-specific geriatric assessment. Eur J Cancer. 2012;48:805–12.CrossRef
20.
Lu J, Cao LL, Zheng CH, et al. The preoperative frailty versus inflammation-based prognostic score: which is better as an objective predictor for gastric cancer patients 80 years and older? Ann Surg Oncol. 2017;24:754–62.CrossRef
21.
Ngo-Huang A, Holmes HM, des Bordes JKA, Parker NH, Fogelman D, Petzel MQB, Song J, Bruera E, Katz MHG. Association between frailty syndrome and survival in patients with pancreatic adenocarcinoma. Cancer Med. 2019;8:2867–76.CrossRef
22.
Harneshaug M, Kirkhus L, Benth JŠ, Grønberg BH, Bergh S, Whist JE, Rostoft S, Jordhøy MS. Screening for frailty among older patients with cancer using blood biomarkers of inflammation. J Geriatr Oncol. 2019;10:272–78.CrossRef
23.
Lealdini V, Trufelli DC, da Silva FB, Normando SR, Camargo EW, Matos LL, Fonseca FL, Santi PX, Del Giglio A. Applicability of modified Glasgow Prognostic Score in the assessment of elderly patients with cancer: a pilot study. J Geriatr Oncol. 2015;6:479–83.CrossRef
24.
Nozoe T, Matsumata T, Sugimachi K. Preoperative elevation of serum C-reactive protein is related to impaired immunity in patients with colorectal cancer. Am J Clin Oncol. 2000;23:263–6.CrossRef
25.
Leitch EF, Chakrabarti M, Crozier JE, McKee RF, Anderson JH, Horgan PG, et al. Comparison of the prognostic value of selected markers of the systemic inflammatory response in patients with colorectal cancer. Br J Cancer. 2007;97:1266–70.CrossRef
26.
Canna K, McArdle PA, McMillan DC, McNicol AM, Smith GW, McKee RF, et al. The relationship between tumour T-lymphocyte infiltration, the systemic inflammatory response and survival in patients undergoing curative resection for colorectal cancer. Br J Cancer. 2005;92:651–4.CrossRef
27.
Du Clos TW, Mold C. C-reactive protein: an activator of innate immunity and a modulator of adaptive immunity. Immunol Res. 2004;30:261–77.CrossRef
28.
Ytting H, Christensen IJ, Basse L, Lykke J, Thiel S, Jensenius JC, et al. Influence of major surgery on the mannan-binding lectin pathway of innate immunity. Clin Exp Immunol. 2006;144:239–46.CrossRef
29.
McMillan DC, Scott HR, Watson WS, Preston T, Milroy R, McArdle CS. Longitudinal study of body cell mass depletion and the inflammatory response in cancer patients. Nutr Cancer. 1998;31:101–5.CrossRef
30.
McMillan DC, Watson WS, O’Gorman P, Preston T, Scott HR, McArdle CS. Albumin concentrations are primarily determined by the body cell mass and the systemic inflammatory response in cancer patients with weight loss. Nutr Cancer. 2001;39: 210–3.CrossRef
31.
Lu Y, Tan CT, Nyunt MS, Mok EW, Camous X, Kared H, Fulop T, Feng L, Ng TP, Larbi A. Inflammatory and immune markers associated with physical frailty syndrome: findings from Singapore longitudinal aging studies. Oncotarget. 2016 17;7:28783–95.CrossRef
32.
Sabel MS, Lee J, Cai M, Englesbe MJ, Holcombe S, Wang S. Sarcopenia as a prognostic factor among patients with stage III melanoma. Ann Surg Oncol. 2011;18:3579–85.CrossRef
33.
Sparchez Z, Mocan T, Radu P, Mocan LP, Sparchez M, Leucuta DC, et al. Prognostic factors after percutaneous radiofrequency ablation in the treatment of hepatocellular carcinoma: impact of incomplete ablation on recurrence and overall survival rates. J Gastrointestin Liver Dis. 2018;27:399–407.CrossRef
34.
Huisingh-Scheetz M, Walston J. How should older adults with cancer be evaluated for frailty? J Geriatr Oncol. 2017;8:8–15.CrossRef
35.
Beggs T, Sepehri A, Szwajcer A, Tangri N, Arora RC. Frailty and perioperative outcomes: a narrative review. Can J Anaesth. 2015;62:143-57.CrossRef
36.
Tanaka S, Ueno M, Iida H, Kaibori M, Nomi T, Hirokawa F, Ikoma H, Nakai T, Eguchi H, Kubo S. Preoperative assessment of frailty predicts age-related events after hepatic resection: a prospective multicenter study. J Hepatobiliary Pancreat Sci. 2018;25:377–387.CrossRef
37.
Gani F, Cerullo M, Amini N, Buettner S, Margonis GA, Sasaki K, Kim Y, Pawlik TM. Frailty as a risk predictor of morbidity and mortality following liver surgery. J Gastrointest Surg. 2017;21:822–830.CrossRef
Metadata
Title
Significance of Frailty in Prognosis After Hepatectomy for Elderly Patients with Hepatocellular Carcinoma
Authors
Shinichiro Yamada, MD, PhD, FACS
Mitsuo Shimada, MD, PhD, FACS
Yuji Morine, MD, PhD, FACS
Satoru Imura, MD, PhD, FACS
Tetsuya Ikemoto, MD, PhD, FACS
Yusuke Arakawa, MD, PhD, FACS
Yu Saito, MD, PhD, FACS
Masato Yoshikawa, MD, PhD
Katsuki Miyazaki, MD
Publication date
01-01-2021
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 1/2021
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-020-08742-w

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