<p>Prediction of chemotherapy adverse reactions and mortality in older patients with primary lung cancer through frailty index based on routine laboratory data</p>

Abstract

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.

A Frailty Index based on clinical data to quantify mortality risk in dogs

“…In humans, FIs based on the clinical data of the patient 11 and on laboratory evaluations (mainly blood tests) have been developed 8,18–20 . An FI combining both clinical and laboratory findings has been developed in mice 21 .…”

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

“…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.…”

“…Two included studies explored the role of prefrailty in predicting the risks of overall mortality in patients with lung cancer (22,23). Figure 2B showed forest plots, which showed the HR of the association between prefrailty and overall mortality.…”

“…Three articles assessed the role of frailty in predicting treatment toxicity, including postoperative complications, chemotherapy adverse reactions, chemotherapy toxicity (16,17,22). As shown in Figure 4A, the pooled OR was 2.60 (95% CI: 0.82-8.24), indicating frailty associated with higher odds of treatment toxicity.…”

The Prevalence of Frailty in Cancer Patients and Mortality Prediction With a Novel Frailty Index Based Clinical Algorithm-A Multicenter, Prospective, Observational Study

“…Several studies reported that aging increased the risk of frailty (26)(27)(28), since the escalating incidence of frailty with old age was associated with the mounting physiological dysregulation with ageing in a nonlinear manner. When frailty is present, stress responses are highly dysregulated and there is high vulnerability to adverse outcomes (25,29,30).…”