Pearce Jessica, Martin Sally, Heritage Sophie, Khoury Emma G, Kucharczak Joanna, Nuamek Thitikorn, Cairns David A, Velikova Galina, Richards Suzanne H, Clegg Andrew, Gilbert Alexandra
Leeds Institute of Medical Research at St James's, University of Leeds, Leeds LS2 9JT, United Kingdom.
Leeds Institute of Oncology, Leeds Teaching Hospitals National Health Service Trust, Leeds LS9 7TF, United Kingdom.
J Natl Cancer Inst. 2025 Jul 1;117(7):1316-1339. doi: 10.1093/jnci/djaf017.
It is increasingly recognized that frailty should be assessed and considered in treatment decision making in patients with cancer. This review and meta-analysis synthesizes existing evidence evaluating the association between baseline frailty and systemic anticancer treatment outcomes in adults with cancer.
Five databases were systematically searched from database inception to January 2023 to identify prognostic factor studies (cohort or case-control design) reporting the associations between validated frailty assessments (pretreatment) and follow-up outcomes in adults with solid-organ malignancy undergoing systemic anticancer treatment. Risk of bias was assessed via Quality of Prognosis Studies in Systematic Reviews tool. Where appropriate, associations between frailty and outcomes (survival, toxicity, treatment tolerance, functional decline/quality of life, and hospitalization) were synthesized in meta-analysis and presented as forest plots.
A total of 58 studies met inclusion criteria. They were undertaken in a range of tumor sites and mainly in older patients and advanced and/or palliative disease settings. Most had low or moderate risk of bias. Nine frailty assessment tools were evaluated. Four outcomes were synthesized in meta-analysis, which demonstrated the prognostic value of 2 tools: Geriatric-8 (survival, treatment tolerance, hospitalization) and Vulnerable Elders Survey-13 (survival, toxicity, treatment tolerance). Overall pooled estimates indicate that frailty conveys an increased risk of mortality (hazard ratio [HR] = 1.68, 95% confidence interval [CI] = 1.41 to 2.00), toxicity (odds ratio [OR] 1.83, 95% CI = 1.24 to 2.68), treatment intolerance (OR = 1.68, 95% CI = 1.32 to 2.12), and hospitalization (OR = 1.94, 95% CI = 1.32 to 2.83).
Simple, brief frailty assessments including Geriatric-8 and Vulnerable Elders Survey-13 are prognostic for a range of important outcomes in patients undergoing systemic anticancer treatment. Risk estimates should be used to support shared decision making.
人们越来越认识到，在癌症患者的治疗决策中应评估并考虑虚弱状态。本综述和荟萃分析综合了现有证据，以评估基线虚弱状态与成年癌症患者全身抗癌治疗结果之间的关联。
从数据库建立至2023年1月，系统检索了五个数据库，以识别预后因素研究（队列或病例对照设计），这些研究报告了经过验证的虚弱评估（治疗前）与接受全身抗癌治疗的实体器官恶性肿瘤成年患者的随访结果之间的关联。通过系统评价中的预后研究质量工具评估偏倚风险。在适当情况下，在荟萃分析中综合虚弱状态与结果（生存、毒性、治疗耐受性、功能下降/生活质量和住院）之间的关联，并以森林图呈现。
共有58项研究符合纳入标准。这些研究在一系列肿瘤部位进行，主要针对老年患者以及晚期和/或姑息性疾病患者。大多数研究的偏倚风险较低或中等。评估了九种虚弱评估工具。在荟萃分析中综合了四种结果，这证明了两种工具的预后价值：老年8项（生存、治疗耐受性、住院）和脆弱老年人调查13项（生存、毒性、治疗耐受性）。总体合并估计表明，虚弱状态会增加死亡风险（风险比[HR]=1.68，95%置信区间[CI]=1.41至2.00）、毒性风险（优势比[OR]=1.83，95%CI=1.24至2.68）、治疗不耐受风险（OR=1.68，95%CI=1.32至2.12）和住院风险（OR=1.94，95%CI=1.32至2.83）。
包括老年8项和脆弱老年人调查13项在内的简单、简短的虚弱评估对于接受全身抗癌治疗的患者的一系列重要结果具有预后价值。风险估计应用于支持共同决策。
