Assessing geriatric vulnerability in older women with advanced ovarian Cancer: Adapting the geriatric vulnerability score for routine clinical practice. The ELCAPA cohort study.

INTRODUCTION: Ovarian cancer is one of the most lethal malignancies in older adults. The Geriatric Vulnerability Score (GVS) may support treatment decisions in this population. We adapted this score, originally developed in clinical trials, for use with routinely collected geriatric oncology data. METHODS: Patients aged ≥70 years with FIGO stage III-IV ovarian cancer from the ELCAPA cohort were included. Two versions of the GVS were developed. The modified GVS (0-5 points) included an Activities of Daily Living score (ADL) <6 or an instrumental Activities of Daily Living score (iADL) <8) at diagnosis, a 4-item Geriatric Depression Scale score ≥ 1, lymphocyte count <1 G/L, and serum albumin <35 g/L. The adapted GVS incorporated dependency measures recorded 3 months before diagnosis. The primary endpoint was 2-year overall survival (OS). RESULTS: Eighty-nine patients were included (median age, 81 years). The 2-year OS rate was 51.6% (95% CI 40.3-61.8). Both scores were associated with OS: HR = 1.45 (95% CI 1.07-1.97; p = 0.016; c-index = 0.646) for the modified GVS and HR = 1.72 (95% CI 1.20-2.47; p = 0.004; c-index = 0.664) for the adapted GVS. In multivariable analysis, a Timed Get-Up-and-Go ≥20 s and the adapted GVS were independently associated with OS, improving discrimination (c-index = 0.7522). CONCLUSION: The GVS can be derived from routinely collected geriatric oncology data. Using dependency measures recorded 3 months before diagnosis slightly improved prognostic performance. Combining the adapted GVS with mobility measures resulted in modestly improved discrimination of mortality risk. Cancer-specific frailty tools may help refine risk stratification and guide treatment decisions in older patients with advanced ovarian cancer.