498P - Frailty-adjusted life expectancy and survival in older lung cancer patients: A large-scale electronic health-record based study

Background

Frailty is of importance for older lung cancer patients, but the remaining lifetime is still not estimated for frailty but solely relied on cancer stage or cell type. In this study, we aimed to estimate survival and life expectancy of older non-small cell lung cancer patients (NSCLC) by frailty status, using electronic-health records.

Methods

We retrospectively analyzed 4260 patients aged between 65 and 95 who were newly diagnosed with NSCLC in 2007-2018 in National Cancer Center, Korea and followed up until December 2020. Frailty was measured by laboratory tests before initial treatment (FI-Lab), then classified into non-frail (score <0.25) and frail groups (score>0.25). Kaplan-Meier curves and log-rank test were used to compare survival probabilities by frailty. Cox proportional hazard model were used to estimate effect of frailty on all-cause mortality, adjusted for age, sex and SEER stage. We also estimate average life expectancy by frailty for all patients and stratified by SEER stage.

Results

There were 1063 (25%) patients identified as being frail. Frail patients had a significantly poorer survival than the non-frail in total population, and in SEER stage groups. Overall, frailty is significantly associated with all-cause mortality (aHR: 1.65, 95% CI: 1.52-1.78). Average life expectancies of frail older patients were 7.75 (95% CI 6.48-9.27) years for localized stage, 3.55 (95% CI 3.05-4.08) years for regional stage and 0.89 (95% CI 0.78-1.02) years for distant stage. While these figures for non-frail patients diagnosed in same cancer stage were 10.05 (95% CI 9.49-11.38), 4.99 (95% CI 4.67-5.32), 1.94 (95%CI 1.82-2.06) respectively.

Conclusions

Survival and life expectancy of older NSCLC patients vary by frailty status. In clinical settings, frailty can be simply assessed by laboratory tests to provide more precise estimates of remaining life-year and help oncologists to better plan for treatment decision and follow-up.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.

Funding

This work was supported by the National Cancer Center Grant (No. NCC-2210880-2, NCC-2310450-1). In addition, one of the authors, Minh Thao Tu was supported by the “International Cooperation & Education Program” (NCCRI·NCCI 52210-52211, 2023)” of National Cancer Center, Korea.

Disclosure

All authors have declared no conflicts of interest.