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Frailty Assessed by the Clinical Frailty Scale is Associated with Prognosis After Esophagectomy

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The Clinical Frailty Scale (CFS) is a simple and validated tool for assessing frailty, and higher CFS scores are correlated with worse perioperative outcomes after cardiovascular surgery. However, the relationship between the CFS scores and postoperative outcomes after esophagectomy remain unclear.

Methods

We retrospectively analyzed data from 561 patients with esophageal cancer (EC) who underwent resection from August 2010 to August 2020. We defined a CFS score of ≥4 as indicative of frailty; thus, patients were classified into frail patients (CFS scores of ≥4) and non-frail patients (CFS scores of ≤3). The Kaplan–Meier method was used to describe the overall survival (OS) distributions with the log-rank test.

Results

Of the 561 patients, 90 (16%) had frailty and 471 (84%) did not. Frail patients had a significantly older age, lower body mass index, higher American Society of Anesthesiologists physical status classification, and greater cancer progression than non-frail patients. The 5-year survival rate was 68% in non-frail patients and 52% in frail patients. OS was significantly shorter in frail than non-frail patients (p = 0.017 by log-rank test). In particular, OS was significantly shorter in frail patients with clinical stage I–II EC (p = 0.0024 by log-rank test) but was not correlated with frailty in patients with clinical stage III–IV EC (p = 0.87 by log-rank test).

Conclusions

Preoperative frailty was associated with shorter OS after resection of EC. The CFS score may be a prognostic biomarker for patients with EC, especially early-stage EC.

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Acknowledgment

The authors thank Angela Morben, DVM, ELS, from Edanz (https://jp.edanz.com/ac), for editing a draft of this manuscript.

Funding

This study did not receive any funding.

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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

    Atsushi Morito MD, Kazuto Harada MD, PhD, Masaaki Iwatsuki MD, PhD, Yuto Maeda MD, Chishou Mitsuura MD, Tasuku Toihata MD, PhD, Keisuke Kosumi MD, PhD, Kojiro Eto MD, PhD, Shiro Iwagami MD, PhD, Yoshifumi Baba MD, PhD, Yuji Miyamoto MD, PhD, Naoya Yoshida MD, PhD, FACS & Hideo Baba MD, PhD, FACS

Authors
  1. Atsushi Morito MD
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  2. Kazuto Harada MD, PhD
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  3. Masaaki Iwatsuki MD, PhD
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  4. Yuto Maeda MD
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  5. Chishou Mitsuura MD
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  6. Tasuku Toihata MD, PhD
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  7. Keisuke Kosumi MD, PhD
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  8. Kojiro Eto MD, PhD
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  10. Yoshifumi Baba MD, PhD
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  11. Yuji Miyamoto MD, PhD
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  12. Naoya Yoshida MD, PhD, FACS
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  13. Hideo Baba MD, PhD, FACS
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Atsushi Morito, Kazuto Harada, Masaaki Iwatsuki, Yuto Maeda, Chishou Mitsuura, Tasuku Toihata, Keisuke Kosumi, Yoshifumi Baba, Naoya Yoshida and Hideo Baba. The first draft of the manuscript was written by Atsushi Morito and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Hideo Baba MD, PhD, FACS.

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Disclosure

Atsushi Morito, Kazuto Harada, Masaaki Iwatsuki, Yuto Maeda, Chishou Mitsuura, Tasuku Toihata, Keisuke Kosumi, Kojiro Eto, Shiro Iwagami, Yoshifumi Baba, Yuji Miyamoto, Naoya Yoshida, and Hideo Baba declare that they have no conflicts of interest.

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Morito, A., Harada, K., Iwatsuki, M. et al. Frailty Assessed by the Clinical Frailty Scale is Associated with Prognosis After Esophagectomy. Ann Surg Oncol 30, 3725–3732 (2023). https://doi.org/10.1245/s10434-023-13313-w

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  • DOI: https://doi.org/10.1245/s10434-023-13313-w

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