Comparing Outcomes of Patients With Early-Stage Non–Small-Cell Lung Cancer Treated With Stereotactic Body Radiotherapy Based on Frailty Status

Raghavan, Govind; Shaverdian, Narek; Chan, Shawna T.; Chu, Fang; Lee, Percy

doi:10.1016/j.cllc.2018.05.008

Cited by 21 publications

(9 citation statements)

References 35 publications

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“…Studies found that unadjusted association estimates might overestimate the impacts of frailty on prognosis of lung cancer. Frailty was significantly associated with shorter OS on univariate analysis [HR = 2.22 (95% CI, 1.22-4.05)], while the value of HR decreased to 1.98 (95% CI, 1.02-3.85) (15). When adjusted for other factors, such as clinical stage and age et al, the value of HR decreased from 3.00 (95% CI, 2.15-4.18) to 2.13 (95% CI, 1.51-3.00) (22).…”

Section: Discussionmentioning

confidence: 99%

“…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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Section: Discussionmentioning

confidence: 99%

Section: Study Characteristics and Qualitymentioning

confidence: 99%

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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“…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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“…It is caused by a considerable reduction in physiologic reserves and increases the risk of unfavorable clinical outcomes [ 7 ]. A few studies showed that frailty is correlated with reduced overall survival in patients with lung cancer [ 8 , 9 ], and its evaluation can reveal a toxicity risk [ 10 ]. However, frailty’s predictive power and usefulness in patients with EGFR-mutated NSCLC have not yet been effectively demonstrated [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Values of Inflammatory Indexes and Clinical Factors in Patients with Epidermal Growth Factor Receptor Mutations in Lung Adenocarcinoma and Treated with Tyrosine Kinase Inhibitors

Chang

Peng

et al. 2022

JPM

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This study aimed to access the predictive value of inflammatory indices and clinical factors in toxicity and survival in patients with epidermal growth factor receptor (EGFR)-mutated lung adenocarcinoma receiving first-line tyrosine kinase inhibitor (TKI)-treatment. A total of 259 patients with stage IIIB–IV lung adenocarcinoma and actionable EGFR mutation who received first-line TKI treatment between 2008 and 2020 were retrospectively enrolled and analyzed. The prognostic factors of TKI-related toxicity, overall survival (OS), and progression-free survival (PFS) were identified by using logistic regression analysis and Cox proportional hazards models. Pre-TKI high platelet-to-lymphocyte ratio (PLR) was associated with post-TKI anemia. Hypoalbuminemia was associated with acneiform rash. Elderly age (≥70 years) and lower body mass index (<18.5 kg/m2) were also associated with hypoalbuminemia. Elderly age, stage IV, EGFR-mutated with L858R and uncommon mutations, and neutrophil-to-lymphocyte ratio were found to be independent prognostic factors for PFS, while elderly age, uncommon EGFR-related mutations, and lymphocyte-to-monocyte ratio were found to be independent prognostic factors for OS. A useful prognostic scoring tool for improving the survival risk stratification of patients was established by incorporating the above essential factors. Baseline hypoalbuminemia and PLR could be crucial clinical assessment factors when initiating TKI therapy. In addition, the optimization of individualized treatment strategies for these patients may be assisted by using the risk-scoring model.

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Comparing Outcomes of Patients With Early-Stage Non–Small-Cell Lung Cancer Treated With Stereotactic Body Radiotherapy Based on Frailty Status

Cited by 21 publications

References 35 publications

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

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>

Prognostic Values of Inflammatory Indexes and Clinical Factors in Patients with Epidermal Growth Factor Receptor Mutations in Lung Adenocarcinoma and Treated with Tyrosine Kinase Inhibitors

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