Abstract：
BACKGROUND: Older adults undergoing cancer treatment often experience more treatment-related toxicities and increased risk of mortality compared to younger patients. The role of frailty among older individuals as a predictor of outcomes has gained growing significance. We evaluated the association between frailty and overall survival (OS) in patients with hepatocellular carcinoma (HCC) ≥60 years.
METHODS: Older adults ≥60 years with HCC enrolled in a prospective single-institution registry underwent a patient-reported geriatric assessment (GA) covering multiple health domains related to prior to their initial medical oncology appointment. Frailty was measured using a 44-item deficit accumulation frailty index. We categorized patients as robust, pre-frail, and frail using standard cutpoints. The primary outcome was overall survival (OS). Univariable and multivariable models were built to evaluate the association between frailty and OS after adjusting for potential confounders.
RESULTS: Total of 116 older adults with HCC with a median age of 67 years were enrolled; 82% male, 27% Black, and 78% with stage III/IV disease. Overall, 19 (16.3%) were robust, 39 (33.6%) pre-frail, and 58 (50.1%) frail. There were 76 patients receiving liver directed therapy. Of these, 13 (17%) were robust, 26 (34%) were pre-frail, and 37 (49%) were frail. Over a median follow up of 0.9 years, 53 patients died. After adjusting for age, stage, etiology, and Child-Pugh class, being frail (vs. robust) was associated with worse OS (hazard ratio (HR) 2.6 [95% CI 1.03-6.56]; p = 0.04).
CONCLUSIONS: Half of the participants in this study were frail, which was independently associated with worse survival in adults ≥60 years of age with HCC. Identification of pre-treatment frailty may allow opportunities to guide treatment decisions and prognostication.
METHODS: Older adults ≥60 years with HCC enrolled in a prospective single-institution registry underwent a patient-reported geriatric assessment (GA) covering multiple health domains related to prior to their initial medical oncology appointment. Frailty was measured using a 44-item deficit accumulation frailty index. We categorized patients as robust, pre-frail, and frail using standard cutpoints. The primary outcome was overall survival (OS). Univariable and multivariable models were built to evaluate the association between frailty and OS after adjusting for potential confounders.
RESULTS: Total of 116 older adults with HCC with a median age of 67 years were enrolled; 82% male, 27% Black, and 78% with stage III/IV disease. Overall, 19 (16.3%) were robust, 39 (33.6%) pre-frail, and 58 (50.1%) frail. There were 76 patients receiving liver directed therapy. Of these, 13 (17%) were robust, 26 (34%) were pre-frail, and 37 (49%) were frail. Over a median follow up of 0.9 years, 53 patients died. After adjusting for age, stage, etiology, and Child-Pugh class, being frail (vs. robust) was associated with worse OS (hazard ratio (HR) 2.6 [95% CI 1.03-6.56]; p = 0.04).
CONCLUSIONS: Half of the participants in this study were frail, which was independently associated with worse survival in adults ≥60 years of age with HCC. Identification of pre-treatment frailty may allow opportunities to guide treatment decisions and prognostication.
摘要：
背景：与年轻患者相比，接受癌症治疗的老年人通常会经历更多的治疗相关毒性和死亡风险增加。在老年人中，虚弱作为结果预测指标的作用越来越重要。我们评估了肝细胞癌（HCC）≥60岁患者的虚弱与总生存期（OS）之间的关联。
方法：在前瞻性单机构注册登记中登记的≥60岁的HCC老年人在其初始内科肿瘤学预约之前接受了患者报告的涵盖多个健康领域的老年评估（GA）。使用44项赤字累积脆弱指数测量脆弱。我们将患者归类为健壮的，脆弱前，和脆弱的使用标准切割点。主要结果是总生存期（OS）。建立单变量和多变量模型，以在调整潜在的混杂因素后评估脆弱和操作系统之间的关联。
结果：共有116名老年肝癌患者，中位年龄67岁；82%为男性，27%黑色,和78％的III/IV期疾病。总的来说,19（16.3%）表现稳健，39（33.6％）脆弱前，和58（50.1%）脆弱。有76例患者接受肝脏定向治疗。其中,13（17%）是稳健的，26人(34%)处于虚弱状态，和37（49％）是脆弱的。中位随访时间为0.9年，53例患者死亡。在调整了年龄之后,舞台,病因学,还有Child-Pugh班,虚弱(vs.健壮）与OS较差相关（风险比（HR）2.6[95%CI1.03-6.56]；p=0.04）。
结论：这项研究中一半的参与者身体虚弱，这与≥60岁的成人HCC患者的生存率较差独立相关。治疗前虚弱的识别可以提供指导治疗决定和预后的机会。
方法：在前瞻性单机构注册登记中登记的≥60岁的HCC老年人在其初始内科肿瘤学预约之前接受了患者报告的涵盖多个健康领域的老年评估（GA）。使用44项赤字累积脆弱指数测量脆弱。我们将患者归类为健壮的，脆弱前，和脆弱的使用标准切割点。主要结果是总生存期（OS）。建立单变量和多变量模型，以在调整潜在的混杂因素后评估脆弱和操作系统之间的关联。
结果：共有116名老年肝癌患者，中位年龄67岁；82%为男性，27%黑色,和78％的III/IV期疾病。总的来说,19（16.3%）表现稳健，39（33.6％）脆弱前，和58（50.1%）脆弱。有76例患者接受肝脏定向治疗。其中,13（17%）是稳健的，26人(34%)处于虚弱状态，和37（49％）是脆弱的。中位随访时间为0.9年，53例患者死亡。在调整了年龄之后,舞台,病因学,还有Child-Pugh班,虚弱(vs.健壮）与OS较差相关（风险比（HR）2.6[95%CI1.03-6.56]；p=0.04）。
结论：这项研究中一半的参与者身体虚弱，这与≥60岁的成人HCC患者的生存率较差独立相关。治疗前虚弱的识别可以提供指导治疗决定和预后的机会。
