Frailty Index for prediction of surgical outcome in ovarian cancer: Results of a prospective study

Abstract

BackgroundComplete macroscopic tumor resection is the strongest prognostic factor for patients with ovarian cancer, which requires complex surgery for achievement. Based on the mostly advanced tumor stage and high symptom burden many patients are classified as frail which may limit optimal surgical outcome. Aim of this study is to evaluate the predictive ability of Frailty Index for surgical outcomes in patients with ovarian cancer. MethodsThis prospective study enrolled patients with ovarian cancer undergoing cytoreductive surgery. We classified frailty proposed by Mitnitski et al. regarding the cumulative deficit model of frailty. Utilizing Receiver Operator Characteristic (ROC) analysis and logistic regression, we determined predictive clinical factors for severe postoperative complications. The Kaplan-Meier method and log-rank test were used for overall survival analysis. ResultsOut of f 144 enrolled patients, the overall prevalence of frailty based on a Frailty Index >0.26 and Frailty Index >0.15 was 33% and 74%, respectively. The logistic regression shows that frail patients with a Frailty Index >0.26 (Odds ratio (OR): 3.64, 95% CI: 1.34–9.85, p = 0.01), ECOG PS > 1 (OR 6.33, 95% CI:1.31–30.51, p = 0.02) and high surgical complexity score (OR 8.86, 95% CI:1.88–41.76, p = 0.006) had a significant higher risk for severe postoperative complications. According to multivariable cox regression Frailty Index >0.15 (hazard ratio (HR) (HR 1.87, 95% CI: 1.01–3.47, p = 0.048), residual tumor <1 cm (HR 2.75, 95%CI: 1.53–4.99, p = 0.001), residual tumor >1 cm (HR 5.00, 95% CI: 2.74–9.13, p < 0.001) and albumin<35.5 g/dl (HR 1.92, 95% CI: 1.08–3.43, p = 0.03) resulted as significant parameters for poor overall survival. Resulted as significant parameters for poor overall survival. ConclusionNext to surgical complexity score, ECOG PS > 1 and recurrent surgery, Frailty Index >0.26 is associated with severe postoperative complications in patients with ovarian cancer. Besides tumor residuals and low albumin levels a Frailty Index >0.15 predicts poor survival.