Use of frailty to predict survival in elderly patients with early stage non-small-cell lung cancer treated with stereotactic body radiation therapy

Franco, Idalid; Chen, Yu Hui; Chipidza, Fallon E.; Agrawal, Vishesh; Romano, John; Baldini, Elizabeth H.; Chen, Aileen B.; Colson, Yolonda L.; Hou, Ying; Kozono, David; Wee, Jon O.; Mak, Raymond H.

doi:10.1016/j.jgo.2017.09.002

Cited by 44 publications

(18 citation statements)

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“…In agreement with a previous study in SBRT-treated NSCLC patients by Franco et al, our CSS findings suggest, though not statistically significant, that the majority of these patients died of other causes than lung cancer, and the frail G-8 and HGST group was at the highest risk [41]. In our study, none of the frail G-8 and HGST combination group patients died of lung cancer, demonstrating the importance of a future focus on optimizing age-related comorbidities in older SBRT-treated patients with localized NSCLC.…”

Section: Discussionsupporting

confidence: 92%

Combination of the G-8 Screening Tool and Hand-Grip Strength to Predict Long-Term Overall Survival in Non-Small Cell Lung Cancer Patients Undergoing Stereotactic Body Radiotherapy

Bentsen

Hansen

Ryg

et al. 2021

Cancers

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The Geriatric 8 (G-8) is a known predictor of overall survival (OS) in older cancer patients, but is mainly based on nutritional aspects. This study aimed to assess if the G-8 combined with a hand-grip strength test (HGST) in patients with NSCLC treated with stereotactic body radiotherapy can predict long-term OS better than the G-8 alone. A total of 46 SBRT-treated patients with NSCLC of stage T1-T2N0M0 were included. Patients were divided into three groups: fit (normal G-8 and HGST), vulnerable (abnormal G-8 or HGST), or frail (abnormal G-8 and HGST). Statistically significant differences were found in 4-year OS between the fit, vulnerable, and frail groups (70% vs. 46% vs. 25%, p = 0.04), as well as between the normal and abnormal G-8 groups (69% vs. 39%, p = 0.02). In a multivariable analysis of OS, being vulnerable with a hazard ratio (HR) of 2.03 or frail with an HR of 3.80 indicated poorer OS, but this did not reach statistical significance. This study suggests that there might be a benefit of adding a physical test to the G-8 for more precisely predicting overall survival in SBRT-treated patients with localized NSCLC. However, this should be confirmed in a larger study population.

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Section: Discussionsupporting

confidence: 92%

Combination of the G-8 Screening Tool and Hand-Grip Strength to Predict Long-Term Overall Survival in Non-Small Cell Lung Cancer Patients Undergoing Stereotactic Body Radiotherapy

Bentsen

Hansen

Ryg

et al. 2021

Cancers

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“…From the early stage to the late stage of lung cancer, the proportion of frailty increased (22). However, there was no significant difference in the incidence of frailty between stage 1A and 1B/2A patients (14). Franco et al (14) found that overall stage did not influence the survival of patients by univariate analysis (1B/2A vs. 1A, P = 0.46).…”

Section: Discussionmentioning

confidence: 97%

“…All of these studies were hospital-based registry cohort studies. A total of 3,921 lung cancer patients involved in these seven studies received different treatments, surgery in two (17,21), radiotherapy in two (14,15), chemotherapy in two (22), unreported in one. Three of these included studies classified patients as prefrail and frail, and one classified patients as mild, moderate and severe frailty.…”

Section: Study Characteristics and Qualitymentioning

confidence: 99%

“…Nevertheless, a phase III trail found the use of CGA to choose treatment did not improve survival but reduce treatment toxicity (13). Some studies found that frailty was associated with reduced overall survival in lung cancer patients (14,15), and frailty assessment might inform toxicity risk (16). However, frailty was found to have no significant predictive value in postoperative outcomes (17).…”

Section: Introductionmentioning

confidence: 99%

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Impacts of Frailty on Prognosis in Lung Cancer Patients: A Systematic Review and Meta-Analysis

et al. 2021

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Background: Frailty is a common geriatric syndrome and is described as a limited ability to compensate and recover from stressors. Lung cancer is largely diagnosed in old age, when frailty is common and might have predictive value on prognosis. Therefore, we performed a systematic review to evaluate the prognostic role of frailty in lung cancer.Methods: The online PubMed, Web of Science, CNKI and Wanfang literature databases were searched to identify all related articles that reported the predictive value of frailty for mortality and therapeutic toxicity. Review Manager 5.3 was used to analyze results by standard meta-analysis methodology.Results: Seven studies were included in this review, and only six studies with 2,359 patients were enrolled in meta-analysis. Patients in two studies received chemotherapy, two studies radiotherapy, two studies surgery, one study not reported. Compared to non-frail patients, frail patients had a higher risk of overall mortality [Hazard Ratio (HR) = 1.57, 95% confidence interval (CI), 1.32–1.87], and therapeutic toxicity [Odds Ratio (OR) = 2.60, 95% CI, 0.82–8.24]. Prefrail patients also showed higher overall mortality and therapeutic toxicity than non-frail patients (HR = 1.20, 95% CI, 1.05–1.38; OR = 1.72, 95% CI, 1.18–2.51, respectively).Conclusions: Frailty is a powerful predictor of overall mortality and therapeutic toxicity in lung cancer patients.

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“…To some extent, it is reasonable to regard FI-LAB as a risk indicator of poor outcomes after chemotherapy. Simply including frailty assessment in the risk assessment before chemotherapy may help to facilitate appropriate treatment planning for older patients with lung cancer 20–22…”

Section: Discussionmentioning

confidence: 99%

<p>Prediction of chemotherapy adverse reactions and mortality in older patients with primary lung cancer through frailty index based on routine laboratory data</p>

Wang¹,

Zhang²,

Shen³

et al. 2019

CIA

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Objectives To assess the role of a pre-chemotherapy frailty index based on routine laboratory data in predicting mortality and chemotherapy adverse reactions among older patients with primary lung cancer. Design Retrospective cohort study Setting West China Hospital, Chengdu, China Participants We included patients aged ≥60 years with primary lung cancer receiving the first course of chemotherapy. Measurements Data were collected from medical records, local government death databases or telephone interviews. Outcomes included chemotherapy adverse reactions and all-cause mortality. We constructed a frailty index based on 44 laboratory variables (FI-LAB) before chemotherapy, and chose the following cutoff points: robust (0.0–0.2), pre-frail (0.2–0.35) and frail (≥0.35). Results We included 1,020 patients (71.4% male; median age: 65 years old). Both pre-frailty and frailty was associated with any chemotherapy adverse reactions and infections during chemotherapy (OR=3.48, 95%CI: 1.77–6.87; OR=3.58, 95%CI: 1.55–8.26, respectively). Frail patients had a shorter median overall survival rate compared to robust patients (18.05 months vs 38.89 months, log-rank p <0.001). After adjusting for some potential confounding variables, the risk of all-cause mortality was dramatically increased in frail patients (HR:2.13, 95% CI:1.51–3.00) with an average follow-up of 3.9 years. Each 0.01 or per standard deviation (SD) increase in the FI-LAB value significantly increased the HR of death by 2.0% (HR:1.02, 95% CI: 1.01–1.03) and 23.0% (HR: 1.23, 95% CI: 1.13–1.34), respectively. Conclusions Frailty assessed by routine laboratory data indicates increased risks of chemotherapy adverse reactions and death in older patients with primary lung cancer receiving the first course of chemotherapy.

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Use of frailty to predict survival in elderly patients with early stage non-small-cell lung cancer treated with stereotactic body radiation therapy

Cited by 44 publications

References 40 publications

Combination of the G-8 Screening Tool and Hand-Grip Strength to Predict Long-Term Overall Survival in Non-Small Cell Lung Cancer Patients Undergoing Stereotactic Body Radiotherapy

Combination of the G-8 Screening Tool and Hand-Grip Strength to Predict Long-Term Overall Survival in Non-Small Cell Lung Cancer Patients Undergoing Stereotactic Body Radiotherapy

Impacts of Frailty on Prognosis in Lung Cancer Patients: A Systematic Review and Meta-Analysis

<p>Prediction of chemotherapy adverse reactions and mortality in older patients with primary lung cancer through frailty index based on routine laboratory data</p>

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