Evaluation of individual and composite CT-based markers in frailty diagnostics in older patients with cancer undergoing major abdominal surgery.

BACKGROUND: Frailty, a multifactorial syndrome associated with age-related decline in physiological reserves, is a critical determinant of surgical outcomes in the elderly. Comprehensive Geriatric Assessment (CGA) is the gold standard for diagnosing frailty but is resource-intensive. This study investigates the relationship between CT parameters and frailty syndrome based on CGA. Additionally, it aims to evaluate the effectiveness of the proposed composite radiological score in diagnosing frailty and predicting postoperative complications. METHODS: The study was a retrospective analysis of prospectively collected data. Patients ≥ 65, undergoing major abdominal oncologic surgery between January 2022 and August 2023, with available CT scans and preoperative CGA were enrolled. The radiological parameters analyzed included sarcopenia, osteoporosis, renal atrophy, abdominal aorta calcification (AAC) and sarcopenic obesity. These parameters were analyzed both individually and as a composite score in relation to frailty syndrome. RESULTS: A total of 79 patients were included in the study. The median age of included patients was 73 (IQR 68-76). Frailty was diagnosed in 50.63% of the group, with colorectal cancer (37.97%) being the most common indication for surgery. AAC and psoas muscle radiodensity was significantly higher in frail patients, while there were no significant differences in other radiological parameters. The AUROC of the radiological composite frailty score for detecting moderate or severe frailty was 0.686 (p = 0.008). CONCLUSIONS: This study demonstrates that AAC could be considered as a significantly useful radiological marker of frailty, while other individual radiological parameters are insufficient for frailty diagnosis. Moreover, radiological composite frailty score is a promising tool for diagnosing severe frailty.