Frailty based on the memorial Sloan Kettering Frailty Index is associated with surgical decision making, clinical trial participation, and overall survival among older women with ovarian cancer

Filippova, Olga T.; Tin, Amy; Alonso, J Fuertes; Tew, William P.; Gardner, Ginger J.; Sonoda, Yukio; Roche, Kara Long; Zivanovic, Oliver; Dennis, S.; Shahrokni, Armin

doi:10.1016/j.ygyno.2021.03.016

Cited by 17 publications

(21 citation statements)

References 28 publications

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“…This may be explained by the fact that age is associated with increased frailty and decreased ability to heal from surgical stress. 31,32 Our findings are consistent with a recent study using the Memorial Sloan Kettering surgical frailty index (MSK-FI) reporting that patients with a higher frailty score were less likely to undergo PCS (OR: 0.64, p < 0.01) and had lower OS (HR: 1.16, p < 0.005), 14 though no significant difference in MSK-FI scores were observed between treatment groups in our study.…”

Section: Discussionsupporting

confidence: 92%

“…We chose a cut‐off of 70 as this is above the median age of diagnosis of AEOC and around the time that physiologic changes would confer variations in prognosis and treatment response related to aging 13 . Other studies have also used this cut‐off 13,14 . Patients with Stage I–II ovarian cancer, age <70 years, nonepithelial, mucinous ovarian cancers, or lost to follow‐up/treatment at another center were excluded from the analysis.…”

Section: Methodsmentioning

confidence: 99%

“…The MSK‐FI included 11 factors, 10 related to comorbidities (chronic obstructive pulmonary disease or pneumonia within 30 days before surgery, diabetes, congestive heart failure, myocardial infarction, coronary artery disease, hypertension, peripheral vascular disease, impaired sensorium including Alzheimer disease, delirium, dementia, Lewy body disease, mild cognitive impairment, and memory loss, cerebrovascular accident, and transient ischemic attack) and 1 related to performance status (impairment in bathing, dressing, grooming, or walking outside. Patients with an MSK‐FI score of more than 3 are considered “frail” 14,16 . “Extensive procedures” are defined in Table 2.…”

Section: Methodsmentioning

confidence: 99%

“…13 Other studies have also used this cut-off. 13,14 Patients with Stage I-II ovarian cancer, age <70 years, nonepithelial, mucinous ovarian cancers, or lost to follow-up/ treatment at another center were excluded from the analysis.…”

Section: Patient Populationmentioning

confidence: 99%

“…Patients with an MSK-FI score of more than 3 are considered "frail". 14,16 "Extensive procedures" are defined in Table 2. SCS was defined as a summation of scores based on complexity of procedures performed to achieve optimal cytoreduction after maximal surgical effort as defined by Aletti et al 17 and was reported as a continuous value.…”

Section: Definitionsmentioning

confidence: 99%

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Treatment outcomes and predictive factors in patients ≥70 years old with advanced ovarian cancer

Piedimonte

Bernardini

May

et al. 2021

Journal of Surgical Oncology

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Objective To evaluate treatment outcomes, survival, and predictive factors in patients ≥70 with advanced epithelial ovarian cancer (AEOC). Methods A retrospective single institution cohort study of women ≥70 with Stage III–IV AEOC between 2010 and 2018. Patients had either primary cytoreductive surgery (PCS), neoadjuvant chemotherapy (NACT) with interval cytoreductive surgery (ICS), chemotherapy alone, or no treatment. Demographics, surgical outcome, complications, and survival outcome were compared between groups. Results Among 248 patients, 69 (27.7%) underwent PCS, 99 (39.9%) had ICS, 56 (22.5%) had chemotherapy alone. Twenty‐four (9.6%) remained untreated. Optimal cytoreduction (≤1 cm) was achieved in 72.4% of PCS and 77.8% of NACT/ICS (p = 0.34), without difference in grade ≥3 postoperative complications (15.9% vs. 9.1%, p = 0.37). Progression‐free survival (PFS) was 23.5 months in PCS and 15.0 months in ICS patients (hazard ratio [HR]: 1.4, p = 0.041). Patients in the surgical arms, PCS or ICS, had better 2‐year overall survival (OS) compared to chemotherapy alone (79%, 68%, 41%, respectively, HR: 3.58, p < 0.001). In a subgroup analysis, patients ≥80 had improved 2‐year OS when treated with NACT compared to PCS (82% vs. 57%) and a trend toward improved PFS. Age, stage, and CA‐125 were determinants of undergoing PCS. Conclusion In patients ≥70 with AEOC, surgery should not be deferred based on age alone. Fit, well selected patients ≥70 can benefit from PCS, while patients ≥80 might benefit from NACT over PCS.

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Section: Discussionsupporting

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Patient Populationmentioning

confidence: 99%

Section: Definitionsmentioning

confidence: 99%

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Treatment outcomes and predictive factors in patients ≥70 years old with advanced ovarian cancer

Piedimonte

Bernardini

May

et al. 2021

Journal of Surgical Oncology

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Influence of interdisciplinary frailty screening on perioperative complication rates in elderly ovarian cancer patients: results of a retrospective observational study

Anić

Varchola

Schmidt

et al. 2022

Arch Gynecol Obstet

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Purpose Frailty is a frequent and underdiagnosed multidimensional age-related syndrome, involving decreased physiological performance reserves and marked vulnerability against major stressors. To standardize the preoperative frailty assessment and identify patients at risk of adverse surgical outcomes, commonly used global health assessment tools were evaluated. We aimed to assess three interdisciplinary preoperative screening assessments to investigate the influence of frailty status with in-hospital complications irrespective of surgical complexity and radicality in older women with ovarian cancer (OC). Methods Preoperative frailty status was examined by the G8 geriatric screening tool (G8 Score-geriatric screening), Eastern Cooperative Oncology Group performance status (ECOG PS-oncological screening), and American Society of Anesthesiologists Physical Status System (ASA PS-anesthesiologic screening). The main outcome measures were the relationship between perioperative laboratory results, intraoperative surgical parameters and the incidence of immediate postoperative in-hospital complications with the preoperative frailty status. Results 116 consecutive women 60 years and older (BMI 24.8 ± 5.2 kg/m2) with OC, who underwent elective oncological surgery in University Medical Center Mainz between 2008 and 2019 were preoperatively classified with the selected global health assessment tools as frail or non-frail. The rate of preoperative anemia (hemoglobin ≤ 12 g/dl) and perioperative transfusions were significantly higher in the G8-frail group (65.9% vs. 34.1%; p = 0.006 and 62.7% vs. 41.8%, p = 0.031; respectively). In addition, patients preoperatively classified as G8-frail exhibited significantly more postoperative clinical in-hospital complications (27.8% vs. 12.5%, p = 0.045) independent of chronological age and BMI. In contrast, ECOG PS and ASA PS did not predict the rates of postoperative complications (all p values > 0.05). After propensity score matching, the complication rate in the G8-frail cohort was approximately 1.7 times more common than in the G8-non-frail cohort. Conclusion Preoperative frailty assessment with the G8 Score identified elderly women with OC recording a significantly higher rate of postoperative in-hospital complications. In G8-frail patients, preoperative anemia and perioperative transfusions were significantly more recorded, regardless of chronological age, abnormal BMI and surgical complexity. Standardized preoperative frailty assessment should be added to clinical routine care to enhance risk stratification in older cancer individuals for surgical patient-centered decision-making.

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Frailty and Cancer Prognosis

Navarrete-Reyes,

Mateos-Soria,

Sánchez-Hernández

et al. 2024

Curr Oncol Rep

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Frailty based on the memorial Sloan Kettering Frailty Index is associated with surgical decision making, clinical trial participation, and overall survival among older women with ovarian cancer

Cited by 17 publications

References 28 publications

Treatment outcomes and predictive factors in patients ≥70 years old with advanced ovarian cancer

Treatment outcomes and predictive factors in patients ≥70 years old with advanced ovarian cancer

Influence of interdisciplinary frailty screening on perioperative complication rates in elderly ovarian cancer patients: results of a retrospective observational study

Frailty and Cancer Prognosis

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