Impact of preoperative geriatric screening and comorbidity assessment in patients with vulvar and vaginal cancer

Abstract

Purpose Patients with vulvar (VC) and vaginal (VaC) cancer are often frail and should be prescreened before a time-consuming comprehensive geriatric assessment (CGA). This study assessed the impact of the preoperatively determined frailty status with the G8 geriatric screening tool (G8) and comorbidity assessment on the outcome of patients with VC/VaC. Methods We conducted an observational study with prospective data collection of patients aged ≥ 60 undergoing surgery for VC and VAC from 05/2020 to 01/2025. Patients were assessed with the G8 tool, age-adjusted Charlson-Comorbidity Index and the Lee-index. Positive G8 results led to CGA-based testing and, if indicated, geriatric consultation. Cox regression, Kaplan–Meier curves and propensity score matching (PSM) were used to analyze the predictive validity of the G8. Results 41 patients were screened. 26 patients were included with a mean follow-up of 23 months. 10 patients were considered G8 positive (G8 ≤ 14 points). Median age was 74.5 (interquartile range: 66–81.3) years. The G8 positive cohort was older, had more comorbidities and had higher ECOG and ASA performance status than the G8 negative cohort. 20% of the G8 positive patients did not receive standard surgical therapy and only one in five patients underwent standard adjuvant radio-/chemotherapy. The univariate Cox-model for overall survival (OS) for G8 positivity had a hazard ratio of 5.65 with 95% CI [1.14–28.1] and a significantly lower 2-year OS (40.0 vs. 85.1%), supported by PSM adjusted for residual confounding (p = 0.017). Conclusions The G8 can be easily implemented in the clinical routine to identify VC and VaC patients with a reduced 2-year OS who may benefit from CGA.