1. Preoperative frailty as a key predictor of short- and long-term outcomes among octogenarians undergoing hepatectomy for hepatocellular carcinoma: a multicenter comprehensive analysis.
- Author
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Yang YF, Zhang P, Wu B, Wang SY, Guo HW, Zheng QX, Chen TH, Li J, Wang XM, Liang YJ, Wang H, Wu XC, Gu WM, Zhou YH, Zeng YY, Diao YK, Yao LQ, Gu LH, Li C, Xu JH, Wang MD, Lau WY, Pawlik TM, Chen Z, Shen F, Lv GY, and Yang T
- Subjects
- Humans, Male, Female, Retrospective Studies, Aged, 80 and over, Risk Factors, Time Factors, Treatment Outcome, Risk Assessment, Frail Elderly, Geriatric Assessment, Postoperative Complications mortality, Postoperative Complications etiology, Age Factors, Hepatectomy mortality, Hepatectomy adverse effects, Liver Neoplasms surgery, Liver Neoplasms mortality, Carcinoma, Hepatocellular surgery, Carcinoma, Hepatocellular mortality, Frailty complications, Frailty mortality
- Abstract
Background: When considering hepatectomy for elderly HCC patients, it's essential to assess surgical safety and survival benefits. This study investigated the impact of preoperative frailty, assessed with the Clinical Frailty Scale (CFS), on outcomes for octogenarians undergoing HCC hepatectomy., Methods: A retrospective cohort study of octogenarians who had hepatectomy for HCC between 2010 and 2022 at 16 hepatobiliary centers was conducted. Patients were categorized as frail or non-frail based on preoperative CFS, with frailty defined as CFS ≥5. The primary endpoints were overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS), with perioperative outcomes as secondary endpoints., Results: Among 240 octogenarians, 105 were characterized as being frail. Frail patients had a higher incidence of postoperative 30-day morbidity and postoperative 30-day and 90-day mortality versus non-frail patients. Meanwhile, 5-year OS, RFS and CSS among frail patients were lower compared with non-frail patients. Univariable and multivariable analysis revealed that preoperative frailty was an independent risk factor of postoperative 30-day morbidity (OR: 2.060), OS (HR: 2.384), RFS (HR: 2.190) and CSS (HR: 2.203)., Conclusion: Preoperative frailty, as assessed by the CFS, was strongly associated with both short-term outcomes and long-term survival among octogenarians undergoing hepatectomy for HCC. Incorporating frailty assessment into the preoperative evaluation may help optimize patient selection and perioperative care., (Copyright © 2024 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2024
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