Tsuyoshi Tanaka1,2, Koichi Suda3,4, Masaki Ueno1, Toshiro Iizuka5, Ichiro Uyama2,6, Harushi Udagawa1. 1. Department of Gastroenterological Surgery, Toranomon Hospital, Minato-ku, Tokyo, Japan. 2. Collaborative Laboratory for Research and Development in Advanced Surgical Technology, Fujita Health University, Toyoake, Aichi, Japan. 3. Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192 , Japan. ko-suda@nifty.com. 4. Collaborative Laboratory for Research and Development in Advanced Surgical Intelligence, Fujita Health University, Toyoake, Aichi, Japan. ko-suda@nifty.com. 5. Department of Gastroenterology, Tokyo Metropolitan Komagome Hospital, Bunkyo-ku, Tokyo, Japan. 6. Advanced Robotic and Endoscopic Surgery, Fujita Health University, Toyoake, Aichi, Japan.
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.
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.
Authors: Myrick C Shinall; Shipra Arya; Ada Youk; Patrick Varley; Rupen Shah; Nader N Massarweh; Paula K Shireman; Jason M Johanning; Alaina J Brown; Neil A Christie; Lawrence Crist; Catherine M Curtin; Brian C Drolet; Rajeev Dhupar; Jennifer Griffin; James W Ibinson; Jonas T Johnson; Sonja Kinney; Chad LaGrange; Alexander Langerman; Gary E Loyd; Leila J Mady; Michael P Mott; Murali Patri; Justin C Siebler; C J Stimson; William E Thorell; Scott A Vincent; Daniel E Hall Journal: JAMA Surg Date: 2020-01-15 Impact factor: 14.766
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Authors: Y Sugita; T Nakamura; R Sawada; G Takiguchi; N Urakawa; H Hasegawa; M Yamamoto; S Kanaji; Y Matsuda; K Yamashita; T Matsuda; T Oshikiri; S Suzuki; Y Kakeji Journal: Dis Esophagus Date: 2021-03-08 Impact factor: 3.429