Prediction of chemotherapy adverse reactions and mortality in older patients with primary lung cancer through frailty index based on routine laboratory data
Authors Wang Y, Zhang R, Shen Y, Su L, Dong B, Hao Q
Received 17 January 2019
Accepted for publication 9 June 2019
Published 5 July 2019 Volume 2019:14 Pages 1187—1197
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 2
Editor who approved publication: Dr Zhi-Ying Wu
Yuting Wang,*,1 Rui Zhang*,2 Yanjiao Shen,1,3 Lin Su,1 Birong Dong,1 Qiukui Hao1
1The Center of Gerontology and Geriatrics/National Center for Geriatric Clinical Research, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 2Health Informatics Center, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; 3Sleep Medicine Center, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
*These authors contributed equally to this work
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.
Keywords: frailty, prognosis, older patients, lung cancer, chemotherapy
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