Background: Co-existing frailty in older patients with hepatopancreaticobiliary (HPB) malignancies is common. This study assessed the relationship between the Rockwood Clinical Frailty scale (CFS) and systemic anti-cancer therapy dose intensity (SACT-DI) and overall survival (OS) in patients with advanced HPB malignancies.
Research design and methods: CFS was assessed prospectively for consecutive patients with newly-diagnosed advanced HPB malignancy (The Christie; Sep-2019 to June-2020). Mann-Whitney U test assessed association between CFS, ECOG Performance Status (ECOG PS) and SACT-DI and Spearman’s rank the association between ECOG PS, age and frailty. Survival analysis was performed using Kaplan-Meier and Cox regression.
Results: Two hundred patients met inclusion criteria. SACT-DI was higher in Group-1 (not frail) (CFS 1-3)(median=61%) than Group-2 (vulnerable/mildly frail) (CFS 4-5)(median=25.1%), p<0.001. There was no statistically significant difference in median SACT-DI in patients with ECOG PS 0 (median=85.1%) and 1 (median=50%), p=0.073. Median OS was shorter in frail and pre-frail patients (HR 2.3(95%CI 1.8-2.9),p<0.001. On multivariable analysis, both CFS (HR 1.5-(95%CI 1.2-1.9), p=0.002) and ECOG PS (HR 1.9 (95%CI 1.6-2.3), p<0.001) were independent prognostic factors for OS.
Conclusion: Frailty assessments, in addition to ECOG PS, may identify patients that will benefit from systemic therapy and are both independent prognostic factors for OS.
Keywords: Dose intensity, ECOG performance status, frailty, hepatopancreaticobiliary malignancies, survival, systemic therapy