The Impact of Frailty in Hepatocellular Carcinoma.

BACKGROUND

Hepatocellular carcinoma (HCC) represents an increasing global health challenge, associated with poor prognosis and an epidemiological shift towards an aging and comorbid population. Frailty is a multidimensional syndrome of reduced physiological reserve. It is recognized as a robust predictor of clinical outcomes in chronic liver disease and some cancers but remains underexplored in HCC.

SUMMARY: This narrative review synthesizes current evidence on the clinical significance of frailty in HCC, focusing on its impact on outcomes, evidence for targeted interventions, and potential role in clinical decision-making. Frailty is associated with adverse outcomes in HCC, including increased healthcare utilization, reduced treatment tolerance, and decreased survival. However, heterogeneity in frailty assessment methods and limited prospective data preclude its clinical application. Early evidence suggests that structured exercise programs are safe, feasible, and may improve frailty measures, although larger prospective studies are required to determine whether these translate into meaningful clinical benefits.

KEY MESSAGES: Frailty is an emerging prognostic marker and may inform supportive care in HCC. Standardized assessment and interventional trials are needed to support routine integration of frailty for more personalized HCC management.