The Liver Cancer and Frailty in Elderly (LIFE) study: Understanding longitudinal functional status in patients with advanced hepatocellular carcinoma (HCC) and aspartate aminotransferase-to-platelet ratio index (APRI).

Abstract

527 Background: Hepatocellular carcinoma (HCC) is a significant contributor to cancer related mortality and morbidity in older adults. Geriatric assessments, such as Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL), offer unique opportunity to evaluate vulnerability of patients with HCC, but their longitudinal relationship to liver-specific biomarkers remains underexplored. The aspartate aminotransferase-to-platelet ratio index (APRI), a widely used surrogate for hepatic fibrosis, may complement these assessments by capturing fibrosis-related functional decline. Our study aims to explore the relationship between APRI and ADL/IADL. Methods: Data from a prospective observational study (NCT03894917) of 80 patients with advanced HCC were analyzed. Self-reported assessments of basic activities of daily living (ADL) and instrumental activities of daily living (IADL) were evaluated at baseline, 2, 4, and 6 months, comparing patients aged <65 and ≥65 years. Liver function was characterized using established scoring systems: Child–Pugh, MELD, and APRI. Results: At baseline, 55% of patients <65 years and 71% of those ≥65 years achieved the highest ADL score. Similarly, 34% of the <65 and 50% of the ≥65 groups reported the highest IADL scores. Over time, ADL scores remained stable in the <65 group, with 100% achieving the highest score by 6 months, whereas in the ≥65 group, this proportion declined to 52%. IADL scores showed a different trend: the proportion achieving the highest score dropped to 13% in the <65 group but remained stable at 57% in the ≥65 group. Correlation analyses demonstrated only weak negative associations between APRI and both ADL (r=–0.18) and IADL (r=–0.07). No significant relationship was observed between functional status and Child-Pugh or MELD scores. Conclusions: Basic functional abilities (ADL) were preserved in younger patients but declined over time in older adults. In contrast, IADL showed an unexpected pattern, with younger patients experiencing greater declines, suggesting early vulnerabilities in complex functional domains despite stable physical functioning. Correlation analyses demonstrated only weak negative associations between APRI and both ADL and IADL, indicating that fibrosis burden did not meaningfully reflect functional independence in this cohort. Future studies should examine how frailty influences tolerance and survival with tyrosine kinase inhibitors (TKIs) versus immuno-oncology (IO) therapies, with the goal of optimizing treatment selection in advanced HCC.