The relationship of preoperative frailty with short- and long-term surgical outcomes among octogenarians with hepatocellular carcinoma: A multicenter comprehensive analysis.

Abstract

e16269 Background: Hepatocellular carcinoma (HCC) management in very elderly individuals, particularly those considering hepatectomy, demands a balanced evaluation of surgical safety and survival outcomes. This multicenter study aims to elucidate the influence of preoperative frailty, as determined by the Clinical Frailty Scale (CFS), on both short-term and long-term outcomes in octogenarians undergoing hepatectomy for HCC. Methods: We conducted a retrospective analysis of a cohort of octogenarians (≥ 80 years) who underwent hepatectomy for HCC from 2010 to 2022 across 16 hepatobiliary centers. Patients were categorized into frail and non-frail groups based on their preoperative CFS scores, with a CFS score of ≥ 5 indicating frailty. We primarily focused on overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS). Secondary endpoints included perioperative outcomes such as postoperative morbidity and mortality. Results: The study encompassed 240 octogenarians, with 105 (43.8%) classified as frail. Frail patients exhibited significantly higher postoperative 30-day morbidity (61.0% vs. 43.0%, P = 0.006) and mortality at both 30-day (5.8% vs. 0.7%, P = 0.045) and 90-day (6.7% vs. 1.5%, P = 0.044) intervals compared to their non-frail counterparts. Furthermore, 5-year OS, RFS, and CSS were markedly lower in frail patients (25.1%, 15.6%, and 43.7% respectively) as opposed to non-frail patients (51.4%, 36.2%, and 66.7%; all P < 0.001). Both univariable and multivariable analyses identified preoperative frailty as an independent risk factor for postoperative 30-day morbidity (OR: 2.060, 95% CI: 1.215-3.494, P = 0.007), as well as for OS (HR: 2.384, 1.682-3.380, P < 0.001), RFS (HR: 2.190, 1.588-3.019, P < 0.001), and CSS (HR: 2.203, 1.397-3.472, P = 0.001). Conclusions: Preoperative frailty emerges as a significant independent predictor of both short-term and long-term outcomes in octogenarians undergoing hepatectomy for HCC. Integrating frailty assessment into preoperative evaluations could substantially enhance patient selection and optimize perioperative management strategies.