衰弱对接受EGFR-TKI治疗的老年非小细胞肺癌患者预后的影响及列线图模型构建

doi:10.3969/j.issn.1003-9198.2026.06.007

Abstract

Abstract: Objective To investigate the impact of frailty before treatment on the prognosis of elderly patients with non-small cell lung cancer (NSCLC) receiving epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) therapy, and to construct a prognostic prediction model. Methods A retrospective analysis was performed on clinical data of 221 elderly NSCLC patients treated with EGFR-TKI in Handan Central hospital from January 2020 to December 2023. The simplified 5-factor modified frailty index (mFI-5) was used to assess frailty status before treatment. Overall survival (OS) was set as the follow-up endpoint, with follow-up ending on August 1, 2025. Results Among the patients, 53 cases (24.0%) had frailty before treatment and 22 cases (10.0%) died during follow-up. Logistic regression analysis indicated that pleural invasion, lymphatic invasion, advanced age, tumor size and smoking index were independently associated with frailty (P<0.05). Cox regression analysis revealed that lymphatic invasion, squamous cell carcinoma, smoking index and frailty status were independent risk factors for poor prognosis (P<0.05). The median survival time of frail patients was 2.71 years, which was significantly shorter than that of non-frail patients (Log rank P<0.001). A nomogram model was constructed based on the above four prognostic risk factors. Internal validation via the Bootstrap method (1000 resamplings) showed that the concordance index (C-index) of the model was 0.79. Receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) of the model for predicting poor prognosis was 0.81(95%CI: 0.69-0.92). Conclusions Frailty status assessed by mFI-5 is associated with decreased OS in elderly NSCLC patients treated with EGFR-TKI. The nomogram model incorporating frailty status, lymphatic invasion, squamous cell carcinoma and smoking index has high predictive value for poor prognosis in these patients.

Key words: aged, non-small cell lung cancer, epidermal growth factor receptor tyrosine kinase inhibitor, frailty, prognosis

CLC Number:

R 743.3

WU Miao, LI Jing, WANG Xiaoying, QIN Mengbin. Impact of frailty on prognosis and construction of nomogram model for elderly patients with non-small cell lung cancer treated with EGFR-TKI[J]. Practical Geriatrics, 2026, 40(6): 573-578.

References

[1] BRAY F, LAVERSANNE M, SUNG H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2024, 74(3): 229-263.
[2] LIU S M, ZHENG M M, PAN Y, et al. Emerging evidence and treatment paradigm of non-small cell lung cancer[J]. J Hematol Oncol, 2023, 16(1): 40.
[3] 宋平安, 陈晓亮, 姚远, 等. 程序性死亡蛋白-1抑制剂单药治疗老年晚期非小细胞肺癌患者的疗效及安全性研究[J]. 中国全科医学, 2023, 26(2): 241-247.
[4] NAVARRETE-REYES A P, MATEOS-SORIA A S, SÁNCHEZ-HERNÁNDEZ J J, et al. Frailty and cancer prognosis[J]. Curr Oncol Rep, 2024, 26(9): 991-1020.
[5] SAPP D G, CORMIER B M, ROCKWOOD K, et al. The frailty index based on laboratory test data as a tool to investigate the impact of frailty on health outcomes: a systematic review and meta-analysis[J]. Age Ageing, 2023, 52(1): afac309.
[6] KOMICI K, BENCIVENGA L, NAVANI N, et al. Frailty in patients with lung cancer: a systematic review and meta-analysis[J]. Chest, 2022, 162(2): 485-497.
[7] TIAN J Y, HAO X Y, CAO F Y, et al. Preoperative frailty assessment predicts postoperative mortality, delirium and pneumonia in elderly lung cancer patients: a retrospective cohort study[J]. Ann Surg Oncol, 2023, 30(12): 7442-7451.
[8] 张从利, 闫妍, 马俊杰, 等. 艾司氯胺酮改善胸腔镜下肺癌根治术老年衰弱患者术后抑郁状态的随机双盲对照试验[J]. 四川大学学报(医学版), 2025, 56(2): 506-513.
[9] BAEK W, PARK S Y, KIM Y. Impact of frailty on the outcomes of patients undergoing degenerative spine surgery: a systematic review and meta-analysis[J]. BMC Geriatr, 2023, 23(1): 771.
[10]MANZETTI M, RUFFILLI A, VIROLI G, et al. Frailty influence on postoperative surgical site infections after surgery for degenerative spine disease and adult spine deformity. Can a frailty index be a valuable summary risk indicator? A systematic review and metanalysis of the current literature[J]. Global Spine J, 2025, 15(2): 1338-1355.
[11]KWEH B T S, LEE H Q, TAN T, et al. Posterior instrumented spinal surgery outcomes in the elderly: a comparison of the 5-item and 11-item modified frailty indices[J]. Global Spine J, 2024, 14(2): 593-602.
[12]SUGIMOTO S, NAGAI S, ITO K, et al. The impact of frailty on surgical outcome of patients with lumbar spinal canal stenosis[J]. Spine Surg Relat Res, 2023, 8(2): 188-194.
[13]OTTAVIANO K E, PALANGE D C, HILL S S, et al. Use of a 5-item modified frailty index for assessing outcomes after hartmann's reversal: an ACS-NSQIP study[J]. Am Surg, 2024, 90(4): 875-881.
[14]CANALES C, MAZOR E, COY H, et al. Preoperative point-of-care ultrasound to identify frailty and predict postoperative outcomes: a diagnostic accuracy study[J]. Anesthesiology, 2022, 136(2): 268-278.
[15]BARBE-RICHAUD J B, FATTORI A, LINDNER V, et al. EGFR-mutant urothelial carcinoma harboring an Ala750_Ile759delinsGlyGly alteration with a primary resistance to polychemotherapy and a sensitivity to osimertinib: a literature review on EGFR alterations and response to EGFR tyrosine kinase inhibitors in cancers[J]. J Clin Med, 2025, 14(9): 3129.
[16]ZHOU H Q, ZHANG Y X, CHEN G, et al. Gefitinib (an EGFR tyrosine kinase inhibitor) plus anlotinib (an multikinase inhibitor) for untreated, EGFR-mutated, advanced non-small cell lung cancer (FL-ALTER): a multicenter phase Ⅲ trial[J]. Signal Transduct Target Ther, 2024, 9(1): 215.
[17]CHEN C L, WANG S T, LIAO W C, et al. A real-world study comparing perioperative chemotherapy and EGFR-tyrosine kinase inhibitors for treatment of resected stage Ⅲ EGFR-mutant adenocarcinoma[J]. BMC Cancer, 2023: 23(1): 847.
[18]ZHANG X, GUO X, GAO Q, et al. Association between cigarette smoking history, metabolic phenotypes, and EGFR mutation status in patients with non-small cell lung cancer[J]. J Thorac Dis, 2023, 15(10): 5689-5699.

Impact of frailty on prognosis and construction of nomogram model for elderly patients with non-small cell lung cancer treated with EGFR-TKI

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 15

Metrics

Recommended 10

[1]	DU Juan, ZHANG Liying, WU Chenkai. Research progress on physical resilience and functional recovery in older adults following acute stress [J]. Practical Geriatrics, 2026, 40(6): 545-550.
[2]	MA Ya, LIU Xiaolei. Effect of physical resilience on the occurrence and development of frailty and its intervention potential [J]. Practical Geriatrics, 2026, 40(6): 556-560.
[3]	WANG Shuo, WANG Jinfeng, LI Ying. Analysis of factors influencing physical resilience in older adults from the perspective of the biopsychosocial model [J]. Practical Geriatrics, 2026, 40(6): 561-565.
[4]	ZHENG Hui, WANG Ying, DAI Hui. Association between the cardiometabolic index and cardiometabolic multimorbidity in older adults: uric acid as a potential mediator and combined predictive value [J]. Practical Geriatrics, 2026, 40(6): 591-596.
[5]	XU Yufeng, ZHOU Min, SHEN Xin, YONG Yonghong. Transesophageal echocardiography combined with agitated saline contrast echocardiography in the diagnosing and characteristic analysis of elderly patients with patent foramen ovale [J]. Practical Geriatrics, 2026, 40(6): 597-601.
[6]	XU Jie, GENG Jin, ZENG Yang, ZHANG Qing, WANG Bingjian. Clinical study on the correlation between TRAF3IP2 expression level and coronary artery calcification in the elderly [J]. Practical Geriatrics, 2026, 40(6): 602-606.
[7]	CAI Yongliang, SUN Heliang, JIANG Yihao, WANG Zhongyun. Comparison of patient-controlled intravenous analgesia with oliceridine or sufentanil on postoperative pain and quality of recovery in elderly patients after thoracoscopic pulmonary resection [J]. Practical Geriatrics, 2026, 40(6): 607-612.
[8]	LIU Yuting, LIU Wen, JI Muhuo. Correlation between perioperative dynamic change of C-reactive protein and the risk of postoperative delirium in elderly patients undergoing non-cardiac surgery [J]. Practical Geriatrics, 2026, 40(6): 613-618.
[9]	SHEN Bo, CAO Mei, HUI Wenqing, ZHANG Pingyang. Evaluation of left ventricular myocardial mechanical properties in aged patients with coronary heart disease using three-dimensional speckle tracking imaging [J]. Practical Geriatrics, 2026, 40(6): 619-623.
[10]	CHANG Meng, ZHU Huanhuan, MA Huizhen, LI Yao, CHEN Yan. Summary of the best evidence for improving cough ability in elderly patients with post-stroke cough dysfunction [J]. Practical Geriatrics, 2026, 40(6): 635-639.
[11]	NI Fangfang, YE Lei, ZHANG Yingbei, CHEN Jiawei, ZHANG Yaojin, CUI Wei. Construction and application of diversified non-drug intervention program for delirium in elderly patients undergoing mechanical ventilation after neurosurgery [J]. Practical Geriatrics, 2026, 40(6): 640-645.
[12]	OUYANG Suhui, LIU Yang, FENG Xiaodan. Development and validation of a vaginal microenvironment-based predictive model for prognostic risk in elderly patients with cervical cancer [J]. Practical Geriatrics, 2026, 40(5): 457-463.
[13]	LI Chunfang, LIU Jia, WANG Le, CHEN Jia, PAN Xiaoting. Impact of social frailty on long-term prognosis in elderly patients with stable chronic heart failure [J]. Practical Geriatrics, 2026, 40(5): 464-468.
[14]	LI Shuyi, GUO Jingyi, RUAN Yuan, SUN Xinyi, MIAO Junjun, HUANG Liji, YU Jiangyi, WANG Lijuan. Study on the impact and diagnostic value of triglyceride glucose index and serum uric acid/HDL-C ratio on diabetic kidney disease progression in elderly patients with type 2 diabetes mellitus [J]. Practical Geriatrics, 2026, 40(5): 479-483.
[15]	SHI Yuxi, GU Dayong, ZHOU Lei, LIU Wenqian, WEN Linchun, YE Jinjun. Efficacy and safety of PD-1 inhibitor combined with chemotherapy for recurrent esophageal squamous cell carcinoma in the elderly [J]. Practical Geriatrics, 2026, 40(5): 484-489.