Frailty assessment in elective gastrointestinal oncogeriatric surgery: Predictors of one-year mortality and functional status Chiara Giannotti a,d,1 , Silvia Sambuceti a,d,1 , Alessio Signori b , Alberto Ballestrero a,d , Roberto Murialdo d , Emanuele Romairone c , Stefano Scabini c , Irene Caffa a , Patrizio Odetti a,d , Alessio Nencioni a,d, ⁎⁎, Fiammetta Monacelli a,d, ⁎ a Geriatrics Clinic, Department of Internal Medicine and Medical Specialties (DIMI), University of Genoa, 16132 Genoa, Italy b Department of Health Science (DISSAL), University of Genoa, 16132 Genoa, Italy c Oncological Surgery and Implantable Systems, Hospital Policlinic San Martino, Genoa, Italy d IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy abstract article info Article history: Received 31 August 2018 Received in revised form 3 April 2019 Accepted 21 April 2019 Available online xxxx Objectives: Perioperative frailty assessment is still a challenge, especially in oncogeriatrics. We aimed at assessing the diagnostic accuracy of the 40 items Frailty Index (FI) as compared to the comprehensive geriatric assessment (CGA) for the prediction of one-year mortality and functional status after colorectal surgery in old-age subjects. Material and methods: Ninety-nine consecutive patients aged 65 years or older who were candidate for elective gastrointestinal cancer surgery, with G8 score ≤ 14 were enrolled and subjected to CGA and to frailty stratification according to the 40-items FI. Long-term outcomes including one-year mortality and functional decline were col- lected. Results: Mean patient age was 80.3 ± 5.6 years. Colorectal cancer was the most common diagnosis. The most prevalent clinical phenotype was pre-frail. CGA and FI showed similar predictive accuracy in identifying one- year mortality after surgery and patient functional status. Our multivariate analysis indicated the pre-morbid functional status (IADL) and cancer stage as the most significant predictors of one-year mortality. Conclusions: This is the first study to investigate the prognostic accuracy of the 40-items FI as compared to CGA in a vulnerable octogenarian cancer population. Its results are consistent with patient functional status being a me- diator of frailty and with both serving as intertwined markers of clinical vulnerability. In addition, according to our results, cancer and specific environmental stressors, such as surgery, are likely to affect the frailty trajectory. © 2019 Elsevier Ltd. All rights reserved. Keywords: Older adults Cancer Surgery Frailty assessment Long-term mortality and functional decline 1. Introduction Due to the aging of populations worldwide and to the rising inci- dence of cancer with age, the surgical management of older patients is becoming more and more a key issue [1]. Surgery is the most efficient treatment for several solid cancers and recent technical advances with improved perioperative care have led to an increased number of older adults eligible for oncogeriatric surgery [2,3] . Postoperative mortality is a key outcome measure after cancer surgery, especially for high-risk older populations. However, while most studies considered 30-day postoperative mortality as a clinical end point, there is increasing evidence for a high mortality beyond 30 days [4]. Indeed, the exceeding postoperative mortality, up to 1 year after sur- gery, has been indicated as the most discriminant factor for long-term survival in elderly patients with colorectal cancer [5,6]. Journal of Geriatric Oncology xxx (2019) xxx Abbreviations: CGA, Comprehensive Geriatric Assessment; SIOG, International Society of Geriatric Oncology; NCCN, National Comprehensive Cancer Network; EORTC, European Organization for Research and Treatment of Cancer; FI, Frailty Index; SF36, Short Form 36; MNA, Mini Nutritional Assessment; GA, geriatric assessment; MMSE, Mini Mental State Examination; CDT, Clock Drawing Test Shulman; GDS, Geriatric Depression Scale; I-ADL, Instrumental Activities of Daily Living; TUG, Timed “Up & Go” test; CIRS, Cumulative Illness Rating Scale; SI, Illness Severity Index; CI, Co-morbidity Index; NRS, Numeric Rating Scale; SVI, social vulnerability index; SD, standard deviation; IQR, median and inter- quartile range; AUC, Area under the curves;; ROC, Receiver operating characteristic. ⁎ Correspondence to: Fiammetta Monacelli, Assistant Researcher in Geriatrics, DIMi, Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy. ⁎⁎ Correspondence to: Alessio Nencioni, Department of Internal Medicine and Medical Specialties, University of Genoa, Genoa, Italy. E-mail addresses: alessio.nencioni@unige.it (A. Nencioni), fiammetta.monacelli@unige.it (F. Monacelli). 1 Equally contributing first authors. JGO-00733; No. of pages: 8; 4C: https://doi.org/10.1016/j.jgo.2019.04.017 1879-4068/© 2019 Elsevier Ltd. All rights reserved. Contents lists available at ScienceDirect Journal of Geriatric Oncology Please cite this article as: C. Giannotti, S. Sambuceti, A. Signori, et al., Frailty assessment in elective gastrointestinal oncogeriatric surgery: Predictors of one-year mortal..., J Geriatr Oncol, https://doi.org/10.1016/j.jgo.2019.04.017