P1.233. Impact of Preoperative Frailty on Long-Term Survival Following Esophagectomy for Esophageal Cancer

Abstract

Esophageal Cancer: Surgical Treatment of Esophageal Cancer – long term outcomes Esophagectomy can provide cure for esophageal cancer yet is associated with high rates of perioperative morbidity. Assessing frailty in the preoperative setting provides superior insight into patients’ physiological reserve and their ability to survive adverse postoperative events. This study evaluates the long-term impact of frailty on survival outcomes. A single institution retrospective analysis (2000-2014) was conducted on 398 patients who underwent esophagectomy for esophageal cancer. Clinical characteristics analyzed included BMI, comorbidities, performance status, and preoperative chemoradiation. Frailty was measured using the modified Frailty Index (mFI-5) score and was defined as mFI-5 ≥2. Cox regression models were used to evaluate relevant covariates including frailty status, age, surgical approach, comorbidities, induction therapy, pathologic stage, and histology on long-term survival outcomes. The cohort had mean age 62.8 ± 11.7, was predominantly male (81.2%) and overweight/obese (66%). 61% received preoperative chemotherapy and 54% also had radiotherapy. mFI-5 scores were 0 (28%), 1 (41%), 2 (25%), 3-4 (6.4%). Cardiovascular and pulmonary complication rates were 31% and 22%. Mortality was 4.9%. On univariate analysis, mFI-5 frailty score, age, CAD, pTNM stage, induction therapy, and squamous histology were significantly associated with worse survival. When categorizing mFI-5 as a binary variable (0-1 vs 2+) and age in 5-year increments, on multivariate analysis frailty, age, induction therapy, worse pathological stage, and squamous histology were significantly associated with worse survival (Table). The hazard ratios were similar among the covariates. Long-term survival was significantly lower in the frail cohort compared to the non-frail cohort, with median overall survival 1.97 vs 4.96 years (Figure, p<0.001). Postoperative survival after esophagectomy is significantly associated with patient preoperative frailty. These findings suggest that preoperative frailty assessment to target prehabilitation strategies, inform risk assessment, and support shared decision making are critical for improving long-term survival in esophageal cancer patients.