Frailty measure is more predictive of outcomes after curative therapy for endometrial cancer than traditional risk factors in women 60 and older

Abstract

Objectives To determine if readily obtainable markers of frailty predict disease-free survival (DFS) in elderly women with endometrial cancer treated with curative intent. Methods 88 consecutive women ≥ age 60 treated with surgery, chemotherapy and radiation for Stage I–IV endometrial cancer were included. We considered the following health deficits as markers of “frailty”: albumin < 3.5 mg/dL, hemoglobin < 10 mg/dL, BMI < 20 kg/m,2 unintentional weight loss, ECOG performance status ≥ 2, history of osteopenia or osteoporosis and Charlson comorbidity score. Kaplan Meier estimates and Cox proportional hazards models of DFS were calculated. Results The median age was 68.5 (range 60–88 years). The majority of women (65/88) had at least one frailty factor at baseline and 23/88 had two or more. All women received radiation and chemotherapy. Treatment was delayed, modified or truncated in 46% (40/88) of women due to treatment-related toxicity. Age (< 70 vs. ≥70 y) did not independently predict toxicity or recurrence risk. Women with at least one baseline frailty factor had twice the risk of disease recurrence (HR=2.21;95% CI: 1.02–4.80) when adjusted for age, stage, grade and Charlson score. The 3-year DFS was 77% in those with no frailty markers and 48% in those with at least one (p=0.02). The presence of a frailty marker also predicted shortened overall survival (HR=2.34;95%CI: 1.08–5.03) irrespective of treatment administered and stage of disease. Conclusions A combined frailty measure was a more robust predictor of DFS and OS than patient age, tumor characteristics and comorbidities in this cohort of older women with very good functional status.

American Society of Anesthesiologists physical status score as a predictor of long-term outcome in women with endometrial cancer

“…However, the current findings can be considered to be consistent with an earlier report in which frailty (ie, state of low functional reserve seen particularly in old subjects) predicted shortened overall survival and disease-free survival in women with endometrial cancer 31. It could be speculated that the partly subjective nature of the ASA physical status classification system allows frailty and other difficultly measurable clinical findings to be translated into a worse classification 32.…”

Lymphadenectomy in elderly patients with high-intermediate-risk, high-risk or advanced endometrial cancer: Time to move from personalized cancer medicine to personalized patient medicine!

“…As for all observational data, there is a potential selection bias: unobserved dimensions of health status, such as performance status, may determine treatment and independently affect survival without involving the choice of the patient (44). Driver JA et al, for example, showed that frailty was a more robust predictor of DFS and OS than patient age and tumor characteristics in a cohort of older women with EC (45). Nevertheless, in present study, except for a higher mean age in the group of patients without lymphadenectomy, the number of comorbidities was similar in both groups as were all the tumor characteristics.…”

An artificial immune system with bootstrap sampling for the diagnosis of recurrent endometrial cancers

“…In addition, early diagnosis of recurrence should not be neglected in the treatment of radiotherapy [20] and surgery [21], and long-term follow-up should be considered [22]. In particular, older patients with endometrial carcinoma are more likely to fare worse than younger patients, independent of other poor prognostic factors [23]. Similarly, the behavior code [24] appeared to be correlated with recurrence.…”