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

Abstract

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 the association of frailty with disease-free survival (DFS) and overall survival (OS). 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, the largest diameter of liver 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]: 2.64, 95% confidence interval [CI]: 1.19–5.25, P = 0.019) and OS (HR: 4.17, 95%CI: 1.43–10.89, P = 0.011). Conclusion: Preoperative frailty was associated with worse DFS and OS after upfront hepatectomy for CRLM. Assessment and improvement of patient vulnerability may provide a favorable prognosis for patients with CRLM.