Prevalence of Frailty in Patients with Hepatocellular Carcinoma: A real-world observational Study

Background and Aim: Frailty represents a state of vulnerability to multiple internal physiologic factors and external pressures and has been associated with poor clinical outcomes. We aimed to find the prevalence and impact of frailty on patients diagnosed with hepatocellular carcinoma (HCC). Methods: This was a cross-sectional study with prospective enrollment carried out at PGIMER, Chandigarh, India. 100 consecutive patients with HCC aged >18 years, were included in the study. The diagnosis of HCC was based on clinical, biochemical, and ultrasonography, and typical radiological findings on CT or MRI scans. The primary outcome was to determine the prevalence of frailty as measured by Liver Frailty Index (LFI). Results: The most common etiology of HCC was Chronic hepatitis C (CHC) in 30%(n=30) patients followed by NASH in 24% (n=24) patients. Most of the patients were in BCLC stage C (37%, n=37) followed by BCLC B (27%, n=27). The prevalence of frailty in patients with HCC was 47% (n=47). There was a significant difference in the LFI (4.82±0.29 vs 4.11±0.27, p=0.0001) in frail versus not frail patients. Patients with frailty had higher CTP score [7(5-10) vs 5(5-9)] and class B (48.9% vs 18.9%, p=.003) than patients in the non-frail group. On multivariable analysis, CTP score [6.203(1.60-24.05), p=.008] was identified as an independent predictor of frailty. 72.3% patients received treatment in frail versus 73.6% patients in not frail group. Tyrosine Kinase inhibitors (TKIs) alone were given in [11 (23.4%) vs 8 (15%), p=0.020] in frail and non-frail patients. Locoregional therapy (LRT) was given in [18 (32.7%) vs 20 (37.7%), p=0.020] in frail and non-frail patients. Conclusion: This study highlights the high prevalence of frailty in patients with HCC, advocating frailty assessment in all patients. Frail patients tend to receive less locoregional treatment as compared to not frail patients.