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Impact of frailty on the long-term outcomes of elderly patients with esophageal squamous cell carcinoma

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Abstract

Objective

We aimed to clarify the association between frailty evaluated using the clinical frailty scale (CFS) and outcomes in elderly patients with esophageal squamous cell carcinoma.

Methods

We retrospectively included 67 patients (aged ≥ 75 years) diagnosed with esophageal squamous cell carcinoma (tumor depth ≥ m3) between 2011 and 2016. The patients were retrospectively evaluated and categorized according to their CFS scores (1–7) and divided into non-frailty (scores 1–2) and frailty groups (scores 3–7). Postoperative complications, 5 year survival rate, and prognostic risk factors were analyzed.

Results

Significant differences in performance status, American Society of Anesthesiologists-Physical Status score, Charlson comorbidity index, and treatment type were observed between the two groups. Thirty-six patients underwent surgery, and morbidities with Clavien–Dindo grades ≥ II and ≥ IIIa were found in 72.2 and 47.2% of the patients, respectively. The remaining 31 patients underwent endoscopic resection and/or chemo (radio) therapy. The morbidity rate did not differ between the two groups. The 5 year survival rate was 75.3% overall and 92.7 and 60.8% in patients in the non-frailty and frailty groups, respectively (p = 0.007). Multivariate analysis revealed that frailty and cStage ≥ II were independent risk factors of overall survival (p = 0.005 and p = 0.013, respectively) and disease-specific survival (p = 0.048 and p = 0.027, respectively).

Conclusions

Frailty greatly impacts the prognosis of elderly patients with esophageal cancer, regardless of surgical or nonsurgical treatment. The CFS score could be a useful prognostic predictor.

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References

  1. Kitagawa Y, Uno T, Oyama T, et al. Esophageal cancer practice guidelines 2017 edited by the Japan esophageal society: Part 1. Esophagus. 2019;16:1–24.

    Article  Google Scholar 

  2. Kitagawa Y, Uno T, Oyama T, et al. Esophageal cancer practice guidelines 2017 edited by the Japan esophageal society: Part 2. Esophagus. 2019;16:25–43.

    Article  Google Scholar 

  3. Hamamoto Y, Sakakibara N, Nagashima F, et al. Treatment selection for esophageal cancer: evaluation from a nationwide database. Esophagus. 2018;15:109–14.

    Article  Google Scholar 

  4. Miyata H, Yamasaki M, Makino T, et al. Clinical outcome of esophagectomy in elderly patients with and without neoadjuvant therapy for thoracic esophageal cancer. Ann Surg Oncol. 2015;22(Supplement 3):S794–801.

    Article  Google Scholar 

  5. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146–56.

    Article  CAS  Google Scholar 

  6. Rockwood K, Song X, MacKnight C, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173:489–95.

    Article  Google Scholar 

  7. van Deudekom FJ, Klop HG, Hartgrink HH, et al. Functional and cognitive impairment, social functioning, frailty and adverse health outcomes in older patients with esophageal cancer, a systematic review. J Geriatr Oncol. 2018;9:560–8.

    Article  Google Scholar 

  8. Reichart D, Rosato S, Nammas W, et al. Clinical frailty scale and outcome after coronary artery bypass grafting. Eur J Cardiothorac Surg. 2018;54:1102–9.

    Article  Google Scholar 

  9. Tanaka T, Suda K, Inaba K, et al. Impact of frailty on postoperative outcomes for laparoscopic gastrectomy in patients older than 80 years. Ann Surg Oncol. 2019;26:4016–26.

    Article  Google Scholar 

  10. Oken MM, Creech RH, Tormey DC, et al. Toxicity and response criteria of the Eastern cooperative oncology group. Am J Clin Oncol. 1982;5:649–55.

    Article  CAS  Google Scholar 

  11. Kuwano H, Nishimura Y, Oyama T, et al. Guidelines for diagnosis and treatment of carcinoma of the esophagus April 2012 edited by the Japan Esophageal Society. Esophagus. 2015;12:1–30.

    Article  Google Scholar 

  12. Sobin LH, Gospodarowicz MK, Wittekind CH. TNM classification of malignant tumours (7th ed). Chichester West Sussex UK Hoboken NJ: John Wiley and Sons; 2010.

    Google Scholar 

  13. 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.

    Article  Google Scholar 

  14. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250:187–96.

    Article  Google Scholar 

  15. Onodera T, Goseki N, Kosaki G. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi. 1984;85:1001–5.

    CAS  PubMed  Google Scholar 

  16. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40:373–83.

    Article  CAS  Google Scholar 

  17. Nakajo K, Abe S, Oda I, et al. Impact of the Charlson comorbidity index on the treatment strategy and survival in elderly patients after non-curative endoscopic submucosal dissection for esophageal squamous cell carcinoma: a multicenter retrospective study. J Gastroenterol. 2019;54:871–80.

    Article  CAS  Google Scholar 

  18. Shah R, Attwood K, Arya S, et al. Association of frailty with failure to rescue after low-risk and high-risk inpatient surgery. JAMA Surg. 2018;153: e180214. https://doi.org/10.1001/jamasurg.2018.0214.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Shinall MC Jr, Arya S, Youk A, et al. Association of preoperative patient frailty and operative stress with postoperative mortality. JAMA Surg. 2020;155: e194620. https://doi.org/10.1001/jamasurg.2019.4620.

    Article  PubMed  Google Scholar 

  20. Tachimori Y, Ozawa S, Numasaki H, et al. Comprehensive registry of esophageal cancer in Japan, 2012. Esophagus. 2019;16:221–45.

    Article  Google Scholar 

  21. Sugita Y, Nakamura T, Sawada R, et al. Safety and feasibility of minimally invasive esophagectomy for elderly esophageal cancer patients. Dis Esophagus. 2021. https://doi.org/10.1093/dote/doaa083.

    Article  PubMed  Google Scholar 

  22. Kanda M, Koike M, Tanaka C, et al. Feasibility of subtotal esophagectomy with systematic lymphadenectomy in selected elderly patients with esophageal cancer; a propensity score matching analysis. BMC Surg. 2019;19:143. https://doi.org/10.1186/s12893-019-0617-2.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Ishii K, Tsubosa Y, Niihara M, et al. Changes in the nutritional status of elderly patients after esophagectomy. Esophagus. 2019;16:408–12.

    Article  Google Scholar 

  24. Ruol A, Portale G, Castoro C, et al. Effects of neoadjuvant therapy on perioperative morbidity in elderly patients undergoing esophagectomy for esophageal cancer. Ann Surg Oncol. 2007;14:3243–50.

    Article  Google Scholar 

  25. Hiraoka A, Saito K, Chikazawa G, et al. Modified predictive score based on frailty for mid-term outcomes in open total aortic arch surgery. Eur J Cardiothorac Surg. 2018;54:42–7.

    Article  Google Scholar 

  26. Li P, Wang X, Lai Y, et al. The prognostic value of pre-treatment prognostic nutritional index in esophageal squamous cell carcinoma: a meta-analysis. Medicine. 2019;98: e15280. https://doi.org/10.1097/MD.0000000000015280.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Lindenmann J, Fink-Neuboeck N, Avian A, et al. Preoperative glasgow prognostic score as additional independent prognostic parameter for patients with esophageal cancer after curative esophagectomy. Eur J Surg Oncol. 2017;43:445–53.

    Article  CAS  Google Scholar 

  28. Nishijima TF, Esaki T, Morita M, Toh Y. Preoperative frailty assessment with the Robinson frailty score, edmonton frail scale, and G8 and adverse postoperative outcomes in older surgical patients with cancer. Eur J Surg Oncol. 2021;47:896–901.

    Article  Google Scholar 

  29. Robinson TN, Wu DS, Pointer L, et al. Simple frailty score predicts postoperative complications across surgical specialties. Am J Surg. 2013;206:544–50.

    Article  Google Scholar 

  30. Okabe H, Ohsaki T, Ogawa K, et al. Frailty predicts severe postoperative complications after elective colorectal surgery. Am J Surg. 2019;217:677–81.

    Article  Google Scholar 

  31. Misawa N, Higurashi T, Tachikawa J, et al. Clinical impact of evaluation of frailty in endoscopic submucosal dissection for early gastric cancer in elderly patients. Geriatr Gerontol Int. 2020;20:461–6.

    Article  Google Scholar 

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Acknowledgements

The authors would like to thank MARUZEN-YUSHODO Co., Ltd. (https://kw.maruzen.co.jp/kousei-honyaku/) for the English language review.

Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Toranomon Hospital, Minato-ku, Tokyo, Japan

    Tsuyoshi Tanaka, Masaki Ueno & Harushi Udagawa

  2. Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University, Toyoake, Aichi, Japan

    Tsuyoshi Tanaka & Ichiro Uyama

  3. Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192 , Japan

    Koichi Suda

  4. Collaborative Laboratory for Research and Development in Advanced Surgical Intelligence, Fujita Health University, Toyoake, Aichi, Japan

    Koichi Suda

  5. Department of Gastroenterology, Tokyo Metropolitan Komagome Hospital, Bunkyo-ku, Tokyo, Japan

    Toshiro Iizuka

  6. Advanced Robotic and Endoscopic Surgery, Fujita Health University, Toyoake, Aichi, Japan

    Ichiro Uyama

Authors
  1. Tsuyoshi Tanaka
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  2. Koichi Suda
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  3. Masaki Ueno
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  4. Toshiro Iizuka
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  5. Ichiro Uyama
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  6. Harushi Udagawa
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Contributions

TT and KS: contributed to the study conception, data acquisition, data interpretation, and writing of the manuscript. MU, TI, and HU: contributed to the data acquisition. KS, MU, TI, IU, and HU: contributed to critical revision of the manuscript for essential intellectual content. All the authors approved the final submitted manuscript version and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Koichi Suda.

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All the authors have no commercial association with or financial involvement that might pose a conflict of interest in connection with the submitted article.

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Tanaka, T., Suda, K., Ueno, M. et al. Impact of frailty on the long-term outcomes of elderly patients with esophageal squamous cell carcinoma. Gen Thorac Cardiovasc Surg 70, 575–583 (2022). https://doi.org/10.1007/s11748-022-01807-5

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  • DOI: https://doi.org/10.1007/s11748-022-01807-5

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