Significance of frailty in mortality and complication after hepatectomy for patients with liver cancer: a systematic review and meta-analysis

Background: Frailty has been associated with increased mortality and complications among liver cancer patients. However, the frailty prevalence and outcomes in frail populations with primary liver cancer have not been systematically validated.

Methods: Embase, PubMed, Scopus, and Web of Science were searched for eligible studies that explored the prevalence and impact of frailty in liver cancers from inception until October 26, 2023. The pooled prevalence, hazard ratio (HR), and odds ratio (OR) corresponding to 95 % confidence intervals (CI) in mortality and major complication estimates were conducted.

Results: A total of 18 studies containing 38,157 primary liver cancer patients were included. The prevalence of frailty in liver cancer was 35 % (95 % CI = 25-46; p = 0.000). Frailty was associated with an increased hazard ratio for 30-day mortality (HR = 7.03; 95 % CI = 0.71-69.45; p = 0.97) and 90-day mortality (HR = 4.59; 95 % CI = 1.76-11.95; p = 0.38). Furthermore, frailty was associated with an increased odds ratio for major complications in liver cancer patients (OR = 4.01; 95 % CI = 2.25-7.14; p = 0.49).

Conclusion: Frailty is frequent in liver cancer patients and may predict adverse outcomes in primary liver cancer patients with hepatectomy. Our findings highlight the importance of frailty assessment in this population.