Abstract

Aim: The management of elderly patients with advanced squamous cell lung cancer (SqCLC) necessitates a nuanced understanding of biological rather than chronological age. While platinum-based doublets remain a therapeutic component, the primary clinical challenge is maintaining treatment continuity. This study investigates the impact of a multidimensional "Triple-Risk Score"—incorporating Psoas Muscle Index (PMI), Clinical Frailty Scale (CFS), and Prognostic Nutritional Index (PNI)—on chemotherapy tolerability and treatment adherence.
Materials and Methods: Data from 43 male patients (≥ 65 years) with stage IIIB-IV SqCLC treated with first-line gemcitabine plus carboplatin were analyzed. A "Triple-Risk Score" (0–3) was derived from morphological (low PMI), functional (high CFS), and nutritional (low PNI) vulnerabilities. The primary endpoint was treatment continuity, defined by the number of completed chemotherapy cycles.
Results: Median overall survival was 16.6 months. A total of 164 cycles were administered (mean 3.8 ± 1.2 per patient). Dose modifications were required in 32.6% of cases. Multivariate analysis confirmed frailty (HR: 4.94, 95% CI: 1.72–14.15, p=0.003) and sarcopenia (HR: 3.61, 95% CI: 1.01–12.88, p=0.048) as independent predictors of mortality. While individual markers and the Triple-Risk Score did not significantly correlate with acute Grade 3–4 toxicities (p > 0.05), the score was a potent predictor of treatment attrition. Patients with a score of 3 completed significantly fewer cycles (mean 2.20 ± 0.8) compared to those with a score of 0 (mean 4.06 ± 1.1, p=0.038).
Conclusion: In elderly SqCLC, treatment failure is driven more by cumulative physiological exhaustion than isolated acute toxicity. Integrating PNI with morphological and functional assessments provides superior granularity in identifying patients at risk for premature treatment discontinuation. These findings advocate for a paradigm shift toward pre-therapeutic multidimensional optimization and proactive dose modification to safeguard treatment continuity.

Key words: Squamous cell lung cancer, sarcopenia, gemcitabin, carboplatin, tolerability