The five-item modified frailty index predicts long-term outcomes in elderly patients undergoing colorectal cancer surgery

World Journal of Surgical Oncology

Research

Chiyo Tsutsumi¹  Yoshihiko Sadakari²  Takeshi Aoyagi²  Koichiro Shimonaga²  Kazuhiro Koikawa²  Kayoko Endo²  Takao Tsukahara²  Gentaro Hirokata²  Toshiro Ogata²  Hiroyuki Nakane²  Kazuhisa Kaneshiro²  Ryo Kohata²  Masahiko Taniguchi²  Hiroki Kanno² 

[1] Department of Medical Biostatistics, St. Mary’s Hospital, 422 Tsubukuhonmachi, 830-8543, Kurume, Fukuoka, Japan;Department of Surgery, St. Mary’s Hospital, Tsubukuhonmachi, 830-8543, Kurume, Fukuoka, Japan;

关键词: Five-item modified frailty index;    Colorectal cancer surgery;    Non-colorectal cancer-related death;    Colorectal cancer death;    Long-term survival;   

DOI  :  10.1186/s12957-023-03150-2

 received in 2023-02-17, accepted in 2023-08-16,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundFrailty has been globally recognized as a predictor of adverse postoperative outcomes. Frailty assessment using the five-factor modified frailty index (5-mFI) has recently gained traction; however, long-term outcomes are unknown in colorectal cancer (CRC) surgery. This study aimed to investigate whether the 5-mFI predicted long-term survival and cause of death on the basis of frailty severity in elderly patients who underwent CRC surgery and to determine the risk factors for mortality.MethodsA total of 299 patients underwent CRC surgery with curative intent between January 2013 and December 2017. Patients were divided into three groups by the 5-mFI score: group 1 (5-mFI: 0 or 1; n = 164): no frailty; group 2 (5-mFI: 2; n = 91): moderate frailty; and group 3 (5-mFI: ≥ 3; n = 44): severe frailty. Clinicopathological variables, namely comorbidities, 5-mFI, prognostic nutrition index, operative/postoperative data, and outcome, including cause of death, were compared between the three groups. To identify factors associated with death from CRC- and non-CRC-related causes, univariate and multivariate analyses using a Cox regression model were performed.ResultsThe immediate postoperative morbidity of patients with Clavien–Dindo grade ≥ III complications (9.1%) in group 3 was not significantly different from that in group 1 (9.1%) or group 2 (14.3%); however, the 30-day mortality rate (4.5%) in group 3 was significantly higher. Long-term disease-free survival was similar between frailty groups, suggesting that CRC surgery provides oncological benefit to patients irrespective of frailty. The 5-year survival rates in groups 1, 2, and 3 were 83.5%, 71.2%, and 47.9%, respectively, showing a significantly lower survival rate as frailty advanced. Sixty percent of the deaths in frail patients were due to respiratory failure and cardiovascular diseases. Multivariate analysis demonstrated that advanced age, higher 5-mFI score, and longer postoperative hospital stay were risk factors for mortality unrelated to CRC. Multivariate analysis also revealed that advanced tumor stage, carcinoembryonic antigen ≥ 5 ng/ml, undifferentiated tumor, and R1 resection were risk factors for CRC-related mortality.ConclusionsThe 5-mFI score can predict postoperative short- and long-term outcomes and risk factors for mortality unrelated to CRC. Additionally, long-term survival was negatively associated with the 5-mFI score.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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