Biological frailty and chemotherapy dose intensity independently predict survival in older adults with Stage II-III colon cancer.

IF 2.5 4区医学 Q3 ONCOLOGY

Cancer Chemotherapy and Pharmacology Pub Date : 2026-10-23 DOI:10.1007/s00280-026-04974-x

Ahmet Burak Ağaoğlu, Ferhat Ekinci, Mustafa Şahbazlar, Atike Pinar Erdogan

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Abstract

Purpose: To evaluate the prognostic impact of chemotherapy dose intensity and frailty indices-including the laboratory-based Frailty Index (FI-Lab)-on survival in older adults with stage II-III colon cancer receiving adjuvant chemotherapy.

Methods: This retrospective study included 94 patients aged ≥ 65 years with stage II (high-risk) or stage III colon cancer treated with adjuvant chemotherapy after curative surgery. Frailty was assessed using FI-Lab with a predefined cut-off of 0.25. Measures included the G8 geriatric screening tool, modified 5-item Frailty Index (mFI-5), and Charlson Comorbidity Index (CCI). Patients were categorised as optimal dose completed, optimal dose started with subsequent reduction, or not started at the optimal dose. Overall survival (OS) and disease-free survival (DFS) were analysed using Kaplan-Meier and Cox regression models.

Results: With a median follow-up of 70 months, 28 recurrences (29.8%) and 22 deaths (23.4%) occurred. FI-Lab ≥ 0.25 independently predicted inferior OS (HR: 3.73; p = 0.023) and DFS (HR: 2.81; p = 0.029). G8, mFI-5, and CCI were not independently associated with survival. Dose initiation strategy was also independently associated with outcomes. Compared with the optimal dose completed group, patients not started at the optimal dose had worse OS (HR: 14.41; p = 0.011) and DFS (HR: 5.16; p = 0.013), whereas dose reduction after optimal initiation was not associated with survival.

Conclusions: Laboratory-based frailty and initial dose intensity independently predicted survival in older adults receiving adjuvant chemotherapy for colon cancer. These findings support individualised treatment strategies integrating biological reserve and early treatment intensity.

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生物学脆弱性和化疗剂量强度独立预测老年II-III期结肠癌患者的生存。

目的：评价化疗剂量强度和虚弱指数（包括实验室虚弱指数（FI-Lab））对接受辅助化疗的老年II-III期结肠癌患者生存的影响。方法：本回顾性研究纳入94例年龄≥65岁的II期（高危）或III期结肠癌患者，在根治性手术后接受辅助化疗。使用FI-Lab评估脆弱性，预定义的截止值为0.25。测量方法包括G8老年筛查工具、改良的5项衰弱指数（mFI-5）和Charlson合并症指数（CCI）。患者被分类为完成最佳剂量，最佳剂量开始并随后减少，或未以最佳剂量开始。采用Kaplan-Meier和Cox回归模型分析总生存期（OS）和无病生存期（DFS）。结果：中位随访70个月，复发28例（29.8%），死亡22例（23.4%）。FI-Lab≥0.25独立预测较差的OS （HR: 3.73, p = 0.023）和DFS （HR: 2.81, p = 0.029）。G8、mFI-5和CCI与生存率无独立相关性。剂量起始策略也与结果独立相关。与最佳剂量完成组相比，未以最佳剂量开始的患者的OS （HR: 14.41; p = 0.011）和DFS （HR: 5.16; p = 0.013）更差，而最佳开始后剂量减少与生存无关。结论：基于实验室的虚弱和初始剂量强度独立预测接受结肠癌辅助化疗的老年人的生存。这些发现支持结合生物储备和早期治疗强度的个性化治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancer Chemotherapy and Pharmacology 医学-药学

CiteScore

6.10

自引率

3.30%

发文量

116

审稿时长

2.5 months

期刊介绍： Addressing a wide range of pharmacologic and oncologic concerns on both experimental and clinical levels, Cancer Chemotherapy and Pharmacology is an eminent journal in the field. The primary focus in this rapid publication medium is on new anticancer agents, their experimental screening, preclinical toxicology and pharmacology, single and combined drug administration modalities, and clinical phase I, II and III trials. It is essential reading for pharmacologists and oncologists giving results recorded in the following areas: clinical toxicology, pharmacokinetics, pharmacodynamics, drug interactions, and indications for chemotherapy in cancer treatment strategy.