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Frailty is associated with poor prognosis after resection for pancreatic cancer

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Abstract

Background

With population aging, the number of frail patients with pancreatic cancer has increased. The Clinical Frailty Scale (CFS) is a simple and validated tool to assess frailty, and higher scores predict worse clinical outcomes after cardiovascular surgery. In this retrospective study, we aimed to examine the association of preoperative frailty with prognosis after resection for pancreatic cancer.

Methods

We retrospectively analyzed data from 142 consecutive patients undergoing resection for pancreatic cancer between April 2010 and December 2018. We used the CFS: 1 (very fit) to 9 (terminally ill) to assess frailty and examined associations of the CFS scores with recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). Multivariable Cox proportional hazards models were used to calculate hazard ratios (HRs), controlling for potential confounders.

Results

Of the 142 patients, 113 (80%) had CFS scores of ≤ 3, 13 (9.2%) scores of 4, and 16 (11%) scores of ≥ 5. Scores of ≥ 5 on the CFS were associated with worse CSS (univariable HR: 2.62, 95% confidence interval [CI]: 1.19–5.18, P = 0.019; multivariable HR: 2.49, 95% CI 1.05–5.34, P = 0.039) and OS (univariable HR: 2.42, 95% CI 1.19–4.46, P = 0.016; multivariable HR: 2.25, 95% CI 1.05–4.43, P = 0.038). The association between CFS scores and RFS was not significant in multivariable analysis (univariable HR: 2.11, 95% CI 1.08–3.79, P = 0.030; multivariable HR: 1.47, 95% CI 0.71–2.83, P = 0.29).

Conclusion

Higher scores on the CFS are associated with worse CSS and OS after resection for pancreatic cancer. Preoperative measurement of frailty may improve risk assessment among patients with pancreatic cancer.

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Acknowledgements

We thank Dr. Trish Reynolds, MBBS, FRACP, from Edanz Group (https://en-author-services.edanz.com/ac) for editing a draft of this manuscript.

Funding

This study was funded through JSPS KAKENHI (Grant number 20K17658).

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan

    Kosuke Mima, Hiromitsu Hayashi, Shigeki Nakagawa, Takashi Matsumoto, Shotaro Kinoshita, Kazuki Matsumura, Fumimasa Kitamura, Norio Uemura, Yosuke Nakao, Rumi Itoyama, Takayoshi Kaida, Katsunori Imai, Yo-ichi Yamashita & Hideo Baba

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  1. Kosuke Mima
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  2. Hiromitsu Hayashi
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Correspondence to Hideo Baba.

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Mima, K., Hayashi, H., Nakagawa, S. et al. Frailty is associated with poor prognosis after resection for pancreatic cancer. Int J Clin Oncol 26, 1938–1946 (2021). https://doi.org/10.1007/s10147-021-01983-z

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