A simple clinical risk score can predict frailty in HNSCC patients

Frailty is a predictor of adverse outcomes in cancer patients, but its assessment in head and neck squamous cell carcinoma (HNSCC) patients is often limited due to time-consuming questionnaires being required for comprehensive geriatric assessment. Simple clinical risc scores (CRS) derived from routine laboratory and clinical parameters may provide a pragmatic alternative.

Between July 2021 and December 2022, 131 newly diagnosed HNSCC patients were enrolled and answered G8 and FRAIL Scale questionnaires. After exclusion, 91 patients were eligible for retrospective statistical analysis. A simplified CRS was calculated from age, systolic blood pressure, cholesterol, bilirubin, and alanine transaminase (ALT). Receiver operating characteristic (ROC) analyses evaluated the predictive performance of the CRS for frailty and other parameters.

Mean age was 66.3 years; 79.1% were male. According to G8, 73.6% were frail, while 25.3% were frail according to FRAIL Scale. CRS distribution was predominantly 2 (44.0%) or 3 points (45.1%). ROC analysis showed that the CRS significantly predicted G8-defined frailty (AUC = 0.644, 95% CI 0.522-0.765, p = 0.020). With cut-off 2.5 points, the positive predictive value for frailty was 84.8%. CRS did not predict frailty defined by FRAIL Scale (AUC = 0.52, p = 0.732), ASA classification (AUC = 0.59, p = 0.212), or UICC stage (AUC = 0.58, p = 0.21).

A simple CRS can predict frailty assessed with the G8 questionnaire. CRS may provide a resource-efficient adjunct to automatically identify patients at risk in clinical practice. Prospective multicenter validation is needed.