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

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.

Keywords:

• frailty
• prognosis
• older patients
• lung cancer
• chemotherapy

Acknowledgments

The authors thank Kathleen Steeves at McMaster university for the English revision of our manuscript and appreciate all participants and legal proxies for their great contributions. This work was supported by the National Natural Science Foundation of China (No. 81601220), the Project of Science and Technology Bureau of Sichuan Province (2017FZ0051), the Science Foundation for Young Researchers of Sichuan University (2017SCU11044) and the Project of Health and family planning commission of Sichuan Province (16PJ328). The sponsors played no role in the design, methods, data collection, analysis and preparation of this paper.

Author Contributions

All authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Supplementary material

Table 1 Characteristics of the study population according to frailty assessed by FI-LAB

Table 2 The differences of short-term chemotherapy adverse reactions according to baseline frailty status

Table 3 The associations between frailty and risk of short-term chemo adverse reactions

Table 4 The prognostic role of frailty in predicting all-cause mortality

Table S1 Laboratory variables for frailty index