Distinct roles of WHO Score, CCI, and CFS in prognosis and treatment decisions for non-small cell lung cancer: A retrospective real-world study

Background: : Non-small cell lung cancer (NSCLC) is a major cause of cancer mortality, especially in older adults. While comprehensive patient assessment is crucial, the optimal combination of prognostic tools beyond the standard WHO Score is unclear. This study compared the prognostic value of WHO Score, Charlson Comorbidity Index (CCI), and Clinical Frailty Scale (CFS) in Finnish NSCLC patients. Materials and Methods: : This retrospective multicenter study included 395 NSCLC patients diagnosed in 2018 across five Finnish hospitals. Data on WHO Score, CCI, and CFS were collected (CFS data being available for approximately one-third-of the patients). Treatment allocation associations were analyzed using logistic regression. Survival outcomes (OS and DSS) were assessed using Kaplan-Meier and Cox regression models. Results: WHO Score was the primary predictor for OS and DSS in the main cohort but failed to predict survival in surgically treated patients. In the CFS subgroup (N = 117), CFS was a stronger predictor of treatment allocation than WHO Score (OR=2.57 for non-active treatment per point increase). While CFS was associated with survival, its independent prognostic value was not definitively established. CCI demonstrated limited additional prognostic value. Conclusions: : WHO Score remains a robust prognostic indicator for survival in NSCLC. CFS shows significant potential in reflecting treatment decisions related to frailty, capturing risks not fully addressed by WHO Score. CCI offered minimal additive prognostic information. While WHO Score is fundamental, incorporating CFS enhances frail patient assessment, though its independent survival prediction value warrants further study.