The Fibrosis-4 score is associated with overall mortality and severe haematological toxicity in older patients with cancer: Analysis of two prospective cohort studies.

The management of older adults with cancer is complicated. Although the liver metabolizes most chemotherapy agents, the predictive value of the liver status in older patients with cancer remains unclear. Here, we evaluated the association of the Fibrosis-4 (FIB-4) score with overall mortality and toxicity in older patients with cancer. We analysed data, prior to the initiation of a new treatment modality, of patients with cancer aged over 70 enrolled into two prospective multicentre studies: ELCAPA (main cohort) and PHRC Aquitaine (external validation cohort). Treatment's toxicity was assessed after 6 months and overall mortality after 6 and 12 months of follow-up. Of 989 patients in the main cohort (median age: 81 years), 226 died during the first 6 months of follow-up (22%) and 355 patients (59%) experienced Grade III/IV toxicity. A FIB-4 score >2.67 was associated with 6- and 12-month overall mortality independently of the cancer site, metastasis, chronic heart failure and serum C-reactive protein level (adjusted hazard ratio [95% confidence interval, CI] = 1.62 [1.11-2.37], p = .013 and 1.44 [1.07-1.94], p = .015, respectively) and was independently associated with the occurrence of severe haematological toxicity (adjusted odds ratio [OR] [95% CI] = 1.92 [1.15-3.22], p = .02). In the validation cohort (n = 333), FIB-4 >2.67 was also independently associated with 12-month overall mortality and severe haematological toxicity (adjusted OR [95% CI] = 1.99 [1.03-3.84], p = .039 and 2.53 [1.52-4.21], p < .0001, respectively). In conclusion, a FIB-4 score >2.67 was independently associated with overall mortality and severe haematologic toxicity in older patients with cancer and should be considered when treating this population.