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Overall, Disease-Free Survival Worse in Frail Patients With CRC


Patients with colorectal cancer (CRC) who were also frail were found to have worse survival when compared with patients who weren’t frail.

Frailty could be a marker of poorer overall survival (OS) and disease-free survival (DFS) in patients with colorectal cancer (CRC), according to a review published in Frontiers in Oncology.

CRC is the third most prevalent cancer in men and second in women around the world, with most cases seen in patients who are aged 65 years and older. Frailty is more common in older patients due to natural aging and accompanying weight loss and a decline in functional capacity. Frailty gives patients a higher risk of complications in surgery and chemotherapy, the 2 primary ways to treat CRC. This review aimed to determine the prognostic role of frailty in patients who have CRC.

Colorectal cancer | Image credit: SciePro - stock.adobe.com

Colorectal cancer | Image credit: SciePro - stock.adobe.com

The researchers searched PubMed, Embase, and Web of Science for this review. The databases were searched through September 4, 2023, and all articles had to be in English. Studies were included if they reported the association between CRC and frailty, all patients were adults, and there was at least 1 year of follow-up time. Excluded studies included duplicates, studies that only reported on short-term outcomes, and studies that did not report separate data for CRC.

Data used for this review included details on the gender of each patient, the mean and median age of the patients, the frailty scale, the stage of CRC, treatments, follow-up, and the number of patients considered frail.

There were 15 studies included in this review, 7 of which were retrospective cohort studies and 8 of which were prospective cohort studies. The studies included were conducted in the US, Scandinavia, the Netherlands, Italy, Spain, Germany, Japan, and Australia. There were 45,288 patients included across the 15 studies, of whom 14.5% were frail, though the scale of frailty was different in each study.

Poor OS in CRC was seen in 14 of the included studies in a meta-analysis (HR, 2.11; 95% CI, 1.44-3.08). Subgroup analyses found that poor OS was still statistically significant in all but frailty scales. Cancer-specific survival (CSS) was significantly poorer in CRC when the patient was frail, according to the 2 studies that reported CSS (HR, 4.59; 95% CI, 2.75-7.67). DFS was reported in 5 studies and was found to be significantly poorer in CRC in patients who were frail (HR, 1.46; 95% CI, 1.28-1.66).

There were some limitations to this study. There were differences in the way frailty was assessed in each study, which could have affected the results of the review. The patients included were also at various stages of disease and had a range of different treatments. This review mostly consisted of observational data, which could have an inherent bias. DFS was only reported in 5 of the 15 studies. Additionally, the confounders that were analyzed were different in each study. All studies found an association between frailty and CRC, which could have introduced selection bias.

The researchers concluded that poor OS and DFS was associated with patients with CRC who were frail compared with patients who were not frail. Studies in CRC should focus on a frailty assessment to better assess the association.


Han J, Zhang Q, Lan J, Yu F, Liu J. Frailty worsens long-term survival in patients with colorectal cancer: a systematic review and meta-analysis. Front Oncol. Published online February 9, 2024. doi:10.3389/fonc.2024.1326292

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