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. 2022 Feb 20;11(4):1116.
doi: 10.3390/jcm11041116.

The Prevalence and the Impact of Frailty in Hepato-Biliary Pancreatic Cancers: A Systematic Review and Meta-Analysis

Klara Komici  1 , Micaela Cappuccio  1 , Andrea Scacchi  1 , Roberto Vaschetti  1 , Giuseppe Delli Carpini  1 , Vito Picerno  1 , Pasquale Avella  1 , Maria Chiara Brunese  1 , Giuseppe Rengo  2   3 , Germano Guerra  1 , Leonardo Bencivenga  4   5
Affiliations

The Prevalence and the Impact of Frailty in Hepato-Biliary Pancreatic Cancers: A Systematic Review and Meta-Analysis

Klara Komici et al. J Clin Med. .

Abstract

Background: Frailty has been associated with increased mortality among hepatobiliary pancreatic (HBP) cancer patients. Nevertheless, estimates of frailty prevalence in HBP cancers and the precise average effect regarding mortality remains uncertain. The present systematic review and meta-analysis aimed to quantify: (1) the prevalence of frailty in patients with liver and pancreatic cancers and (2) the impact of frailty on mortality in patients affected by liver and pancreatic cancers.

Methods: MEDLINE/PubMed database search was conducted from inception until 1 November 2021, the pooled prevalence and relative risk (RR) estimate were calculated.

Results: A total of 34,276 patients were identified and the weighted prevalence of frailty was 39%; (95% [C.I.] 23-56; I2 = 99.9%, p < 0.0001). Frailty was significantly associated with increased mortality RR 1.98 (95% [C.I.] 1.49-2.63; I2 = 75.9%, p = 0.006).

Conclusions: Frailty prevalence is common among HBP cancer patients and exerts a significant negative impact on survival. These findings are characterized by significant heterogeneity and caution is warranted on their interpretation. However, stratification of patients with HBP cancer by frailty status may provide prognostic information and may inform priorities for decision-making strategy.

Keywords: biliary cancer; elderly; frailty; hepatic cancer; mortality; pancreatic cancer.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of search strategy and included studies.
Figure 2
Figure 2
Overall prevalence of frailty in patients with HBP cancer. Forest plot of cumulative prevalence of frailty from all included studies. Squares are study-specific prevalence. Diamond is the pooled prevalence. Horizontal lines represent 95% Confidence Interval (CI).
Figure 3
Figure 3
Prevalence of frailty in patients with HPB cancer: identification of frailty based on Fried Frailty Criteria. Forest plot of cumulative prevalence of frailty from all studies applying Fried Phenotype Model. Squares are study-specific prevalence. Diamond is the pooled prevalence. Horizontal lines represent 95% Confidence Interval (CI).
Figure 4
Figure 4
Prevalence of frailty in patients with HPB cancer: identification of frailty based on Modified Frailty Index. Forest plot of cumulative prevalence of frailty from all studies applying Modified Frailty Index. Squares are study-specific prevalence. Diamond is the pooled prevalence. Horizontal lines represent 95% Confidence Interval (CI).
Figure 5
Figure 5
Effect of frailty on mortality in patients with HPB cancer. Forest plot of mortality risk comparing frailty hepatobiliary pancreatic cancers vs. non-frail hepatobiliary pancreatic cancer patients. Squares are study-specific Relative Risk (RR). Diamond is the estimated overall RR. Horizontal lines represent 95% Confidence Interval (CI).
Figure 6
Figure 6
Effect of frailty on mortality in patients with HPB cancer: identification of frailty based on Modified Frailty Index. Forest plot of mortality risk comparing frailty hepatobiliary pancreatic cancers vs. non-frail hepatobiliary pancreatic cancer patients when frailty was identified by Modified Frailty Index. Squares are study-specific Relative Risk (RR). Diamond is the estimated overall RR. Horizontal lines represent 95% Confidence Interval (CI).
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