Association of frailty and malnutrition with overall survival in adults with gastrointestinal cancer: A prospective cohort study

Abstract

Background The mortality burden of patients with gastrointestinal malignancies is increasing worldwide, suggesting the need for more effective prognostic indicators. This study utilized a prospective cohort to (1) analyze the relationship between frailty and malnutrition and their association with the overall survival (OS) in adults with gastrointestinal cancer and (2) explore which specific frailty-related factors most significantly affect the OS. Methods Participants diagnosed with gastrointestinal cancer from 2013 to 2018 who were enrolled in the Investigation on Nutrition Status and Clinical Outcome of Common Cancers study were identified. Malnutrition was determined using the Patient-Generated Subjective Global Assessment, whereas frailty was assessed using the FRAIL scale. The main outcome measured was the all-cause mortality. Multivariable-adjusted logistic regression was used to analyze the cross-sectional link between the nutritional status and frailty. Univariate and multivariate Cox regression analyses were conducted to explore the longitudinal association of these with the OS. Results Among the 4,361 patients enrolled in the study, 1,136 deaths were observed over a median follow-up of 43.4 months. Malnourished patients had a significantly higher risk of frailty than well-nourished patients (OR = 6.25, 95% CI = 5.23–7.51). Frailty and malnutrition independently predicted the OS, with frailty showing an HR of 1.50 (95% CI = 1.33–1.69) and malnutrition showing an HR of 1.51 (95% CI = 1.31–1.74). Patients with both frailty and malnutrition had the highest all-cause mortality risk (HR = 1.82, 95% CI = 1.55–2.14) compared with patients with neither risk factor. Mortality rates rose with the accumulation of additional frailty-related factors. Conclusions Malnutrition and frailty are interrelated prognostic factors in patients with gastrointestinal malignancies, and their simultaneous presence worsens the patient outcomes. Higher scores for resistance and ambulation are major factors associated with a poorer outcome. Future large-scale prospective studies with repeated measurements are necessary to further explore the complex associations among frailty, malnutrition, and the prognosis in patients with gastrointestinal cancer.