Background It is unknown whether the preoperative anesthesiological risk assessment interacts with patient age in colorectal cancer (CRC) to increase the risk of early postoperative mortality beyond that explained by the independent effects of age and anesthesiological risk assessment. Methods We conducted a nationwide cohort study (2014–2023) of all Danish non-metastatic CRC patients (UICC pathological TNM I-III) aged 70 or more years at time of surgery (n = 15,673). To analyse perioperative risk, we used the American Society of Anesthesiologists (ASA) Physical Status Classification system score. The study cohort was stratified by age at CRC surgery (70-79, 80+) and ASA classification (I, II, III). We estimated mortality rates per 1000 person-days, and calculated interaction contrasts as a measure of the excess mortality rate not explained by the independent effects of age or ASA classification. Results 90-day overall survival was lower in patients aged ≥80 years compared with those aged 70–79 years (94.0% vs. 97.9%). Increasing ASA classification was associated with progressively lower survival, with 90-day survival of 98.9% for ASA I, 97.9% for ASA II, and 93.1% for ASA III. Interaction analyses demonstrated that the combined effect of age and ASA classification exceeded their independent effects, with interaction contributing 21% of the mortality rate in ASA II patients aged ≥80 years and 36% in ASA III patients aged ≥80 years. Discussion Old CRC patients assessed as ASA III have a high risk of perioperative mortality and may benefit from risk factor reductions or high intensity postoperative monitoring to reduce mortality.
Background Combined hepatocellular–cholangiocarcinoma (cHCC-CCA) is a rare and heterogeneous primary liver malignancy with poor outcomes after resection. This study aimed to develop and preliminarily validate postoperative prognostic models incorporating clinical, pathological, and inflammatory variables. Patients and methods We retrospectively analyzed 182 patients with pathologically confirmed cHCC-CCA who underwent curative-intent hepatectomy at two centers, including 145 patients in the training cohort and 37 in the external validation cohort. LASSO regression and multivariable Cox regression were used to identify predictors of overall survival (OS) and disease-free survival (DFS). Results Independent predictors of OS were HBV status, tumor differentiation, tumor diameter, HCC AJCC stage, and neutrophil-to-lymphocyte ratio. Independent predictors of DFS were HBV status, MVI, tumor diameter, AFP and monocyte-to-lymphocyte ratio. These factors collectively span the four VITAL dimensions. The VITAL nomograms outperformed conventional HCC and ICC staging systems in both cohorts and effectively stratified patients by risk. Conclusions The VITAL nomogram integrates viral, inflammatory, tumor biological, and anatomical dimensions into a single instrument, providing superior postoperative risk stratification compared with conventional staging in cHCC-CCA. Further multicenter validation is warranted.
