971P - Effect of preoperative frailty on surgical outcomes following hepatic resection for elderly patients with hepatocellular carcinoma: A multicenter retrospective cohort study from China

Background

The growing demand for hepatic resection in elderly hepatocellular carcinoma (HCC) patients highlights the need to understand the impact of preoperative frailty on surgical outcomes. This multicenter retrospective cohort study aimed to investigate the association between frailty and short-term and long-term outcomes following hepatic resection in elderly HCC patients.

Methods

We conducted a multicenter retrospective cohort study on elderly patients (≥70 years) who underwent curative-intent hepatic resection for HCC at 10 Chinese hospitals in China from 2012 to 2021. Frailty was assessed using the Clinical Frailty Scale (CFS), with frailty defined as CFS ≥ 5. Primary outcomes included overall survival (OS) and recurrence-free survival (RFS); secondary outcomes encompassed postoperative 30-day morbidity, 30-day mortality, and 90-day mortality. We compared these outcomes between patients with and without preoperative frailty.

Results

Of the 488 elderly patients, 148 (30.3%) were considered frail. Frail patients experienced significantly higher postoperative 30-day morbidity (68.9% vs. 43.2%), 30-day mortality (4.1% vs. 0.6%), and 90-day mortality (6.1% vs. 0.9%) than non-frail patients (all P<0.05). During a median follow-up of 37.7 months (IQR: 20.4-57.8), frail patients demonstrated significantly worse median OS (41.6 months [95% CI, 32.0-51.2] vs. 69.7 months [95% CI, 55.6-83.8]) and RFS (27.6 months [95% CI, 23.1-32.1] vs. 42.7 months [95% CI, 34.6-50.8]) compared to non-frail patients (both P<0.01). Multivariate Cox-regression analysis revealed frailty as a significant predictor for OS (HR 1.61, 95% CI 1.22-2.13, P=0.001) and RFS (HR 1.32, 95% CI 1.03-1.70, P=0.028).

Conclusions

Frailty was significantly associated with adverse short-term and long-term outcomes in elderly HCC patients undergoing hepatic resection. Our findings suggest that frailty assessment should be incorporated into perioperative and postoperative prognosis evaluation, and particular attention should be given to frail elderly patients undergoing this procedure.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Tian Yang.

Funding

National Natural Science Foundation of China; Dawn Project Foundation of Shanghai; Shanghai Health Academic Leader Program.

Disclosure

All authors have declared no conflicts of interest.