Frailty worsens long-term survival in patients with colorectal cancer: a systematic review and meta-analysis.

Background: Colorectal cancer (CRC) is the 3 most common cancer in men and 2 most common malignancy in females across the globe leading to high mortality rates. Frailty is an age-related syndrome that has been associated with high morbidity and mortality. This systematic review aimed to examine if frailty can predict long-term (>1 year) outcomes of patients with CRC.

Methods: This PROSPERO registered review examined the databases of PubMed, Embase, and Web of Science till 4 September 2023 for cohort studies assessing the association between frailty and long-term outcomes of CRC.

Results: 15 studies with 45288 patients were included. 6573 patients (14.5%) were frail. Meta-analysis demonstrated that frailty was associated with statistically significant poor overall survival (OS) (HR: 2.11 95% CI: 1.44, 3.08 I = 94%) (14 studies), cancer-specific survival (CSS) (HR: 4.59 95% CI: 2.75, 7.67 I = 38%) (2 studies), and disease-free survival (DFS) (HR: 1.46 95% CI: 1.28, 1.66 I = 0%) (5 studies) after CRC. Subgroup analysis for OS based on study type, location, sample size, stage of cancer, percentage with frailty, treatment, adjustment for CRC stage and comorbidities, and follow-up did not change the results. These results were not altered in significance on sensitivity analysis.

Conclusion: Our results show that frail CRC patients have poor OS and DFS as compared to non-frail patients. Variations in frailty measurement tools and high inter-study heterogeneity are major limitations of the review.

Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, PROSPERO, CRD42023450586.