Independent and joint association of sarcopenia and frailty with mortality in older patients with gastrointestinal cancer: A cohort study with prospective data collection

Abstract

Purpose Sarcopenia and frailty are associated with mortality in older patients with gastrointestinal cancer. However, it is unclear if there is an additional risk when both are present. This study aimed to investigate the independent and overlapping of sarcopenia and frailty with mortality in this population. Methods A prospective cohort study including older patients with gastrointestinal cancer. Sarcopenia was defined by the EWGSP2 criteria: i) low muscle strength (handgrip test); ii) low muscle mass (skeletal muscle index) and/or low muscle quality (skeletal muscle radiodensity) by computed tomography. Frailty was defined according to Fried phenotype (at least three of the five components): i) low muscle strength (handgrip test); ii) unintentional weight loss; iii) self-reported exhaustion; iv) low physical activity; v) low gait speed. Cox proportional-hazards model were used to assess overall survival rates and risk of mortality. Results We evaluated 179 patients with gastrointestinal cancer [68.0 (61.0–75.0) years; 45% women]. The prevalence of sarcopenia, frailty, and sarcopenia-frailty was 32.9% (n = 59), 59.2% (n = 106), and 24.6% (n = 44), respectively. The incidence of mortality was 27.9% (n = 50) over a 23-month (IQR:10, 28) period. There was an association of sarcopenia (HR = 1.78, 95% CI 1.03–3.06) with mortality, but no association was found of frailty and the outcome. Sarcopenia-frailty was associated with the highest risk of mortality (HR = 2.23, 95% CI 1.27–3.92). Conclusion Sarcopenic-frail older patients with gastrointestinal cancer have a higher risk of mortality than those with sarcopenia or frailty alone, which reinforces the importance of assessing both conditions in oncology clinical care.