Relationship between frailty and nutrition: refining predictors of mortality after primary cytoreductive surgery for ovarian cancer (066)

Abstract

Objectives: Patients with stage IIIC/IV epithelial ovarian cancer (OC) often require complex operations to achieve primary cytoreductive surgery (PCS). Determining who is at risk for 90-day postoperative mortality after PCS is critically important to maximize oncologic outcomes. Multiple patient factors are associated with poor outcomes, but the interplay between factors is complex. We aimed to examine the interplay between frailty and nutritional status as they relate to 90-day mortality after PCS. Methods: Patients with stage IIIC/IV OC who underwent curative-intent PCS from January 2, 2006, to April 30, 2018, at a single institution were identified from a prospectively maintained database. Preoperative frailty was defined by frailty index (FI), which includes 30 items scored at 0, 0.5, or 1, and calculated by adding all the item scores and dividing by the total number of items available (range: 0-1). Patients with a FI ≥0.15 were considered frail. Nutritional status was dichotomized and considered impaired when preoperative serum albumin was <3.5 g/dL. The ability of factors to discriminate between patients with versus without 90-day mortality was assessed by the AUC estimated by logistic regression models. Conclusions: Using preoperative variables to predict 90-day mortality in OC patients undergoing PDS is an important clinical need. Frailty and impaired nutritional status do not always present with obvious clinical signs and should be specifically measured. Our results demonstrate the benefits of methodical preoperative testing to determine safe operability in PCS. More studies are needed to understand the relationship between frailty and other factors, including age in the advanced OC patient, to maximize benefits and reduce harm. Objectives: Patients with stage IIIC/IV epithelial ovarian cancer (OC) often require complex operations to achieve primary cytoreductive surgery (PCS). Determining who is at risk for 90-day postoperative mortality after PCS is critically important to maximize oncologic outcomes. Multiple patient factors are associated with poor outcomes, but the interplay between factors is complex. We aimed to examine the interplay between frailty and nutritional status as they relate to 90-day mortality after PCS. Methods: Patients with stage IIIC/IV OC who underwent curative-intent PCS from January 2, 2006, to April 30, 2018, at a single institution were identified from a prospectively maintained database. Preoperative frailty was defined by frailty index (FI), which includes 30 items scored at 0, 0.5, or 1, and calculated by adding all the item scores and dividing by the total number of items available (range: 0-1). Patients with a FI ≥0.15 were considered frail. Nutritional status was dichotomized and considered impaired when preoperative serum albumin was <3.5 g/dL. The ability of factors to discriminate between patients with versus without 90-day mortality was assessed by the AUC estimated by logistic regression models. Conclusions: Using preoperative variables to predict 90-day mortality in OC patients undergoing PDS is an important clinical need. Frailty and impaired nutritional status do not always present with obvious clinical signs and should be specifically measured. Our results demonstrate the benefits of methodical preoperative testing to determine safe operability in PCS. More studies are needed to understand the relationship between frailty and other factors, including age in the advanced OC patient, to maximize benefits and reduce harm.