Significance of Frailty in Prognosis After Hepatectomy for Elderly Patients with Hepatocellular Carcinoma

Background The concept of frailty becomes important for patients who undergo surgery in this recent aging society. The aim of this study is to investigate the frailty as a prognostic factor in elderly patients with hepatocellular carcinoma (HCC) who underwent hepatectomy. Patients and Methods A total of 92 patients over 75 years old who underwent hepatectomy were enrolled in this study. Frailty was defined as clinical frailty scale (CFS) >= 4. Patients were divided into two groups, i.e., frailty group (n = 21) and no-frailty group (n = 71), and clinicopathological features were compared between them. Results The frailty group showed significant higher PIVKA-II level and larger tumor diameter (p < 0.05). CRP level and modified Glasgow prognostic score were significantly higher in the frailty group (p < 0.05). The frailty group showed higher rate of postoperative complications of Clavien-Dindo III (p = 0.06) and longer postoperative stay (p = 0.08). Cancer-specific, overall, and disease-free survival rates were significantly worse in the frailty group (p < 0.05). Frailty was detected as an independent prognostic factor on multivariate analysis of cancer-specific survival. Conclusion Frailty can estimate the prognosis of HCC patients who underwent hepatectomy.

Automated summary

Frailty was identified as a prognostic factor in elderly hepatocellular carcinoma (HCC) patients who underwent hepatectomy, with higher postoperative complications and lower survival rates observed in frail patients.