The aim of this study is to investigate the association between frailty and overall survival (OS) and progression-free survival (PFS) in women with endometrial cancer (EC). Frailty is increasingly recognized as a significant predictor of outcomes in cancer patients, yet its impact on survival among EC patients remains unclear. This study is a systematic review and meta-analysis. PubMed, Embase, and Web of Science from database inception to September 28, 2024 were searched for cohort studies evaluating frailty in relation to survival in EC patients. Inclusion criteria focused on studies reporting hazard ratios (HRs) for OS or PFS, comparing frail versus nonfrail patients. A random-effects model was applied. Eight cohort studies involving 486,138 women reported the outcome of OS, and 4 of them involving 378 women also reported the outcome of PFS. Frailty was associated with poor OS (HR: 1.78, 95% confidence interval [CI]: 1.56-2.03, p < 0.001) without significant heterogeneity (I = 0%). Sensitivity analyses confirmed the stability of this association. Subgroup analyses according to the mean age of the patients, tools for evaluating frailty, follow-up duration, and study quality score showed consistent results (p for subgroup difference: 0.35-0.98). Four studies indicated a significant association between frailty and worse PFS (HR: 1.91, 95% CI: 1.24-2.95, p = 0.003), also with no heterogeneity (I = 0%). The results of the study conclude that frailty is associated with poor survival in EC. Although these findings should be validated in large prospective cohort studies, this meta-analysis highlights the possible role of frailty assessment in risk stratification and prognostic prediction of patients with EC. No patient or public contribution.
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