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Patient vulnerability is associated with poor prognosis following upfront hepatectomy for colorectal liver metastasis

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Abstract

Background

With the rapid aging of populations worldwide, the number of vulnerable patients with liver metastasis from colorectal cancer has increased. This study aimed to examine the association between vulnerability and clinical outcomes in patients with colorectal liver metastasis (CRLM).

Methods

Consecutive 101 patients undergoing upfront hepatectomy for CRLM between 2004 and 2020 were included. The preoperative vulnerability was assessed using the Clinical Frailty Scale (CFS) score ranging from one (very fit) to nine (terminally ill), and frailty was defined as a CFS score of ≥ 4. A multivariable Cox proportional hazard regression model was utilized to investigate associations of frailty with disease-free survival (DFS), overall survival (OS), and cancer-specific survival (CSS).

Results

Of the 101 patients, 12 (12%) had frailty. Associations between frailty and surgical outcomes, namely, the incidence of 90-day mortality and postoperative complications, were not statistically significant (P > 0.05). In the multivariable analyses, after adjusting for clinical risk scores calculated using six factors (timing of liver metastasis, primary tumor lymph node status, number of liver tumors, size of the largest tumor, extrahepatic metastatic disease, and carbohydrate antigen 19–9 level) to predict recurrence following hepatectomy for CRLM, preoperative frailty was found to be an independent risk factor for DFS (hazard ratio [HR]:2.37, 95% confidence interval [CI] 1.06–4.72, P = 0.036), OS (HR:4.17, 95% CI 1.43–10.89, P = 0.011), and CSS (HR:3.49, 95% CI 1.09–9.60, P = 0.036).

Conclusion

Preoperative frailty was associated with worse DFS, OS, and CSS after upfront hepatectomy for CRLM. Assessment and improvement of patient vulnerability may provide a favorable prognosis for patients with CRLM.

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Acknowledgements

We would like to thank Editage (www.editage.cn) for editing this manuscript.

Funding

This study was funded by the Takeda Science Foundation, the Kobayashi Foundation for Cancer Research, and the Japanese Foundation For Multidisciplinary Treatment of Cancer.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-Ku, Kumamoto, 860-8556, Japan

    Kosuke Mima, Hiromitsu Hayashi, Yuki Adachi, Takuya Tajiri, Takashi Ofuchi, Kosuke Kanemitsu, Daisuke Ogawa, Shinsei Yumoto, Takashi Matsumoto, Rumi Itoyama, Yuki Kitano, Shigeki Nakagawa, Hirohisa Okabe & Hideo Baba

Authors
  1. Kosuke Mima
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  2. Hiromitsu Hayashi
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Contributions

Study concepts: KM. Study design: KM. Data acquisition: YA, TT, TO, KK, DO, SY, TM, RI, YK, SN, HO. Quality control of data and algorithms: KM, HH. Data analysis and interpretation: KM, HH, HB. Statistical analysis: KM. Manuscript preparation: KM. Manuscript editing: KM, HH. Manuscript review: all authors.

Corresponding author

Correspondence to Hideo Baba.

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Conflict of interest

The authors declare no conflict of interest for this article.

Ethics statement

This study was approved by the Human Ethics Review Committee of Kumamoto University Hospital, Kumamoto, Japan (institutional ethics committee number: 2220). The requirement for written informed consent was waived owing to the retrospective nature of the study.

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Mima, K., Hayashi, H., Adachi, Y. et al. Patient vulnerability is associated with poor prognosis following upfront hepatectomy for colorectal liver metastasis. Int J Clin Oncol 29, 47–54 (2024). https://doi.org/10.1007/s10147-023-02429-4

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  • DOI: https://doi.org/10.1007/s10147-023-02429-4

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