Background/Objectives: Over 60% of diagnoses of head and neck squamous cell carcinoma (HNSCC) occur in patients aged over 65. The benefits of radiotherapy (RT) combined with chemotherapy remain controversial in geriatric patients. Frailty stratification is underutilized in clinical practice despite evidence suggesting its predictive power. We aimed to assess the impact of pre-treatment frailty stratification on overall survival (OS) and acute radiation-related toxicity in a cohort of older patients with HNSCC. Methods: A prospective cohort of 117 patients aged ≥65 years with newly diagnosed HNSCC was enrolled between 2017 and 2022. Patients received RT with or without chemotherapy. Frailty was assessed using the 40-item Frailty Index (FI) as part of a comprehensive geriatric assessment. The primary outcomes were OS and acute RT toxicity, defined as a grade ≥ 3 based on CTCAE 5.0. Cox proportional hazard models and logistic regression models, adjusted for age, tumor stage, and chemotherapy, were used. Results: After a median follow-up of 819 days, FI (HR 1.478, 95% CI 1.182–1.848,p< 0.001) was an independent predictor of OS. Grade ≥ 3 toxicities were observed in 38% of patients, but frailty was not significantly associated with toxicity. A sub-analysis of oropharyngeal carcinoma patients demonstrated improved OS in HPV-positive patients (HR 0.231, 95% CI 0.078–0.686,p= 0.008). Conclusions: the standardized introduction of frailty assessment in the evaluation of older HNSCC patients holds great promise for predicting long-term survival. This approach could be crucial in tailoring treatment protocols that account for the biological heterogeneity of older adults.
背景/目的：超过60%的头颈部鳞状细胞癌（HNSCC）诊断发生于65岁以上患者。在老年患者中，放疗联合化疗的获益仍存在争议。尽管有证据表明衰弱分层具有预测价值，但其在临床实践中应用不足。本研究旨在评估治疗前衰弱分层对老年HNSCC患者总生存期及急性放疗相关毒性的影响。方法：前瞻性纳入2017年至2022年间新诊断的117例年龄≥65岁的HNSCC患者。所有患者均接受放疗，部分联合化疗。采用包含40个条目的衰弱指数作为老年综合评估工具进行衰弱评估。主要结局指标为总生存期和基于CTCAE 5.0标准定义的≥3级急性放疗毒性。研究采用经年龄、肿瘤分期和化疗调整的Cox比例风险模型和逻辑回归模型进行分析。结果：中位随访819天后，衰弱指数（HR 1.478，95% CI 1.182–1.848，p<0.001）是总生存期的独立预测因子。38%的患者出现≥3级毒性，但衰弱与毒性无显著相关性。口咽癌亚组分析显示HPV阳性患者总生存期更优（HR 0.231，95% CI 0.078–0.686，p=0.008）。结论：在老年HNSCC患者评估中标准化引入衰弱评估，对预测长期生存具有重要价值。该方法对于制定考虑老年患者生物学异质性的个体化治疗方案至关重要。
肿瘤(癌症)患者之家