Associations Between G8 Geriatric Screening Score, Charlson Comorbidity Index, AI-Based Age Phenotype, and Overall Survival in Older Adults With Stage I-II Non-Small Cell Lung Cancer.

PURPOSE: Comprehensive geriatric assessment can identify older adult oncology patients at high risk for adverse outcomes, but is variably feasible. Therefore, we assessed whether an abridged geriatric vulnerability model incorporating abstracted G8 score (G8), Charlson Comorbidity Index (CCI), and FaceAge (an AI-based aging measure) was associated with all-cause mortality or falls risk in patients undergoing stereotactic body radiation therapy (SBRT) for early-stage non-small cell lung cancer (NSCLC).

METHODS

We reviewed the records of 708 patients aged ≥65 years with stage I-II NSCLC treated with SBRT from June 1, 2009, to March 31, 2023. We abstracted demographics, functional status (Eastern Cooperative Oncology Group [ECOG] score), oncologic history, G8, CCI, falls risk (Morse Fall Scale or Strategies to Reduce Injuries and Develop Confidence in Elders screening tool), and time-to-death. FaceAge was calculated using AI-based facial analysis of SBRT simulation photographs. We examined associations between a vulnerability model incorporating G8, CCI, and FaceAge, and all-cause mortality and falls risk, using Cox and regression models adjusted for age, sex, stage, ECOG, and significant covariates (P < .10).

RESULTS

Patients (median age, 76.2 years; 60.7% female; median stage IA), commonly had functional limitations (median ECOG, 1; IQR, 1-2), multimorbidity (median CCI, 7; IQR, 6-8), poor G8 scores (median, 12.5; IQR, 11.5-13.5), and elevated biological FaceAge (median 2.6 years above chronological age). In an adjusted Cox regression model, worse performance on all 3 geriatric vulnerability measures was independently associated with higher all-cause mortality (hazard ratio [HR]FaceAge = 1.04, 95% confidence interval [CI]FaceAge, 1.02-1.06, P = .002; HRG8 = 1.15, 95% CIG8, 1.08-1.22, P < .001; HRCCI = 1.14, 95% CICCI, 1.06-1.22, P < .001). However, only worse G8 was associated with falls risk (HR = 1.19; 95% CI, 1.05-1.35; P = .006).

CONCLUSIONS

Among older adults with early-stage NSCLC, a multimodal vulnerability measure leveraging routinely collected data was associated with all-cause mortality, identifying patients who might benefit from additional services.