Department of Geriatric Medicine, All India Institute of Medical Science, New Delhi, India.
Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India.
J Geriatr Oncol. 2024 Apr;15(3):101736. doi: 10.1016/j.jgo.2024.101736. Epub 2024 Feb 29.
Frailty, characterized by ageing-related vulnerability, influences outcomes in older adults. Our study aimed to investigate the relationship between frailty and clinical outcomes in older Indian patients with cancer.
Our observational single-centre study, conducted at Tata Memorial Hospital from February 2020 to July 2022, enrolled participants aged 60 years and above with cancer. Frailty was assessed using the Clinical Frailty Scale (CFS), G8, and Vulnerable Elders Survey (VES)-13. The primary objective was to explore the correlation between baseline frailty and overall survival. Statistical analyses include Kaplan-Meier, Cox proportional hazards, and Harrell's C test.
A total of 1,177 patients (median age 68, 76.9% male) were evaluated in the geriatric oncology clinic. Common malignancies included lung (40.0%), gastrointestinal (35.8%), urological (11.9%), and head and neck (9.0%), with 56.5% having metastatic disease. Using CFS, G8, and VES-13 scales, 28.5%, 86.4%, and 38.0% were identified as frail, respectively. Median follow-up was 11.6 months, with 43.3% deaths. Patients fit on CFS (CFS 1-2) had a median survival of 28.02 months, pre-frail (CFS 3-4) 13.24 months, and frail (CFS ≥5) 7.79 months (p < 0.001). Abnormal G8 (≤14) and VES-13 (≥3) were associated with significantly lower median survival (p < 0.001). Multivariate analysis confirmed CFS's predictive power for mortality (p < 0.001), with hazard ratios [HRs] for pre-frail at 1.61(95% confidence interval [CI] 1.25 to 2.06) and frail at 2.31 (95%CI 1.74 to 3.05). G8 ≤ 14 had HR 2.00 (95%CI 1.42 to 2.83), and abnormal VES-13 had HR 1.36 (95%CI 1.11-1.67). In the likelihood ratio test, CFS significantly improved the model fit (p < 0.001). Harrell's C index for survival prediction was 0.62 for CFS, 0.54 for G8, and 0.58 for VES-13.
In conclusion, our study highlights varying frailty prevalence and prognostic implications in older Indian patients with cancer, emphasizing the need for personalized care in oncology for this aging population. We would recommend using CFS as a tool to screen for frailty for older Indian patients with cancer.
衰弱是一种与衰老相关的脆弱性特征，会影响老年患者的结局。我们的研究旨在探讨衰弱与老年印度癌症患者临床结局之间的关系。
我们的观察性单中心研究于 2020 年 2 月至 2022 年 7 月在塔塔纪念医院进行，纳入年龄在 60 岁及以上的癌症患者。采用临床衰弱量表（CFS）、G8 和脆弱性老年人调查（VES）-13 评估衰弱。主要目的是探索基线衰弱与总生存期之间的相关性。统计分析包括 Kaplan-Meier、Cox 比例风险和 Harrell 的 C 检验。
共有 1177 名（中位年龄 68 岁，76.9%为男性）患者在老年肿瘤诊所接受评估。常见的恶性肿瘤包括肺癌（40.0%）、胃肠道癌（35.8%）、泌尿系统癌（11.9%）和头颈部癌（9.0%），其中 56.5%为转移性疾病。使用 CFS、G8 和 VES-13 量表，分别有 28.5%、86.4%和 38.0%的患者被认定为衰弱。中位随访时间为 11.6 个月，有 43.3%的患者死亡。在 CFS 评分（1-2 分）中，生存中位数为 28.02 个月，介于前衰弱（CFS 评分 3-4 分）和衰弱（CFS 评分≥5 分）之间，分别为 13.24 个月和 7.79 个月（p<0.001）。异常 G8（≤14）和 VES-13（≥3）与显著降低的中位生存期相关（p<0.001）。多变量分析证实 CFS 对死亡率有预测能力（p<0.001），前衰弱的危险比（HR）为 1.61（95%置信区间 [CI] 1.25 至 2.06），衰弱为 2.31（95%CI 1.74 至 3.05）。G8 评分≤14 的 HR 为 2.00（95%CI 1.42 至 2.83），异常 VES-13 的 HR 为 1.36（95%CI 1.11-1.67）。在似然比检验中，CFS 显著改善了模型拟合（p<0.001）。CFS 对生存预测的 Harrell's C 指数为 0.62，G8 为 0.54，VES-13 为 0.58。
总之，我们的研究强调了不同衰弱发生率和对老年印度癌症患者预后的影响，强调了为这一老龄化人群提供个性化肿瘤治疗的必要性。我们建议使用 CFS 作为一种工具来筛查老年印度癌症患者的衰弱。
