G-8 Geriatric Screening Tool Independently Predicts Progression-Free Survival in Older Ovarian Cancer Patients Irrespective of Maximal Surgical Effort: Results of a Retrospective Cohort Study

Abstract

<b><i>Background:</i></b> We evaluated the prognostic impact of various global health assessment tools in patients older than 60 years with ovarian cancer (OC). <b><i>Methods:</i></b> G-8 geriatric screening tool (G-8 score), Lee Schonberg prognostic index, Eastern Cooperative Oncology Group (ECOG) performance status, and Charlson Comorbidity Index (CCI) were determined retrospectively in a consecutive cohort of elderly patients with OC. Univariate and multivariate Cox regression analyses and Kaplan-Meier method were performed to analyze the impact of the preoperative global health status on survival. <b><i>Results:</i></b> 116 patients entered the study. In multivariate analysis adjusted for clinical-pathological factors, only the G-8 score retained significance as a prognostic parameter of progression-free survival (PFS) (hazard ratio [HR]: 1.970; 95% confidence interval [CI] [1.056–3.677]; <i>p</i> = 0.033). Fifty-six patients were classified as G-8-nonfrail with an increased PFS compared to 50 G-8-frail patients (53.4% vs. 16.7%; <i>p</i> = 0.010). A higher CCI was associated with decreased PFS (45.1% vs. 22.2%; <i>p</i> = 0.012), but it did not influence the risk of recurrences or death (<i>p</i> = 0.360; <i>p</i> = 0.111). The Lee Schonberg prognostic index, the ECOG, and age were not associated with survival. <b><i>Conclusions:</i></b> The G-8 score independently predicted PFS in elderly OC patients regardless of maximal surgical effort. Thus, it could be useful to assess surgical treatment based on frailty rather than age alone.

Frailty and long-term survival of patients with ovarian cancer: A systematic review and meta-analysis

“…As presented in Table 1 , nine cohort studies, including two prospective ( 23 , 28 ) and seven retrospective cohorts ( 21 , 22 , 24 – 27 , 29 ), with 2497 patients with OC contributed to the meta-analysis. These studies were published between 2017 and 2022, and performed in the United States ( 22 , 23 , 25 , 27 , 29 ), Italy ( 21 ), France ( 24 ), and Germany ( 26 , 28 ). All of the studies included patients with confirmed diagnosis of OC, and four studies included older patients only ( 21 , 24 , 26 , 27 ).…”

“…However, studies evaluating the correlation between frailty and survival of patients with OC showed inconsistent results ( 21 – 29 ). Some studies suggested that high frailty was associated with poor survival of these patients ( 22 , 24 , 25 , 27 – 29 ), while others failed to show a significant association ( 21 , 23 , 26 ). Therefore, we performed a systematical review and meta-analysis to comprehensively investigate the relationship between frailty and survival of patients with OC.…”

Impact of perioperative red blood cell transfusion, anemia of cancer and global health status on the prognosis of elderly patients with endometrial and ovarian cancer

“…postoperative prognosis (54,55,58). Consecutively, the frailty status was seen as a potential confounder in this study and was included in the multivariate analyses.…”

“…These mainly preoperatively detectable parameters seemed to give important insights into the patients' prognosis regardless of the administration of RBC transfusions. Especially in older women with OC, a multilayered and interdisciplinary diagnostic or rehabilitation program might be helpful to enable an individual therapy concept mainly in frail patients, as G8-frail patients were faced with a poor prognosis irrespectively of maximal surgical effort (58). A moderate transfusion management, based on the fact that RBC transfusions in symptomatic anemic OC patients, was not associated with an overall poorer outcome.…”

“…The patients' preoperative global health status was retrospectively assessed with the G8 score based on the routine pre-surgical patient evaluation. This process has previously been described elsewhere (54,58). Longterm follow-up including progression-free survival (PFS) and overall survival (OS) was performed by telephone calls, written inquiries to the patients or their physicians, and by checking the patient clinical records up to February 2021.…”