Available online 2 July 2022
Highlights•Frailty was associated with poorer oncological and survival outcomes.
•Frail patients had an increased mortality risk (hazard ratio: 2.95, P < 0.001).
•Frailty was associated worse disease-free survival (hazard ratio: 1.80, P < 0.001).
AbstractIntroductionFrailty describes patients who are at an extreme risk of vulnerability to stressors that may lead to adverse clinical outcomes. The impact of frailty on clinical, oncological and survival outcomes in colorectal cancer (CRC) remains unclear.
AimTo determine the anticipated oncological and survival outcomes for patients who are frail when diagnosed and undergo treatment with curative intent for CRC.
MethodsA systematic review and meta-analysis was performed as per PRISMA guidelines. Descriptive statistics were used to determine associations between frailty and survival outcomes. The impact of frailty on disease-free and overall survival were expressed as hazard Ratios (HRs) and 95% confidence intervals (CIs) were estimated using the time-to-effect generic inverse variance and Mantel-Haenszel method.
ResultsNine studies including 15,555 patients were included, of whom 8.1% were frail (1206/14,831). The mean age was 77.1 years (range: 42–94 years), 61.1% were female (9510/15,555) and mean follow-up was 48.0 months. Overall, frailty was associated with an increased risk of mortality (HR: 2.95, 95% CI: 1.64–5.29, P < 0.001) and worse disease-free survival (HR: 1.80, 95% CI: 1.34–2.41, P < 0.001). Frailty was also associated with an increased risk of mortality at 1-year (HR: 3.70, 95% CI: 1.00–13.66, P = 0.050) and 5-years (HR: 2.79, 95% CI: 1.65–4.71, P < 0.001) follow-up respectively.
ConclusionFrailty is associated with poorer oncological and survival outcomes in patients diagnosed and treated with curative intent for CRC. CRC multidisciplinary team meetings should incorporate these findings into the management paradigm for these patients and patient counselling should be tailored to include these findings.
KeywordsColorectal cancer
Frailty
Elderly medicine
Surgical oncology
Precision oncology
View full text© 2022 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.
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