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In oncology, the Performance Status (PS) has long guided therapeutic decisions; however, with the evolution of cancer treatments and the aging of the patient population, a more comprehensive assessment of frailty is emerging as a valuable clinical tool. In patients with cirrhosis, frailty may manifest earlier than in the general population, and the Liver Frailty Index (LFI) has gained prominence as a validated measure among liver transplant candidates. Individuals with hepatocellular carcinoma (HCC) may exhibit frailty due to both the underlying cirrhosis and tumor burden. Nonetheless, evidence on the role of frailty in guiding treatment decisions for HCC remains limited, and standardized assessment tools are still lacking to optimize patient stratification and therapeutic allocation.<\/jats:p>","DOI":"10.3390\/curroncol33010058","type":"journal-article","created":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T14:58:54Z","timestamp":1768834734000},"page":"58","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Frailty in Hepatocellular Carcinoma: An Unsettled Clinical Challenge"],"prefix":"10.3390","volume":"33","author":[{"given":"Antonio","family":"Bonato","sequence":"first","affiliation":[{"name":"Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine (DIMED), University of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1288-709X","authenticated-orcid":false,"given":"Pietro","family":"Guerra","sequence":"additional","affiliation":[{"name":"Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine (DIMED), University of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4548-8308","authenticated-orcid":false,"given":"Alessandro","family":"Vitale","sequence":"additional","affiliation":[{"name":"General Surgery 2, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University of Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7958-1906","authenticated-orcid":false,"given":"Andrea","family":"Martini","sequence":"additional","affiliation":[{"name":"Unit of Internal Medicine and Hepatology (UIMH), Department of Medicine (DIMED), Azienda Ospedale Universit\u00e0 Padova, 35128 Padova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"M146","DOI":"10.1093\/gerona\/56.3.M146","article-title":"Frailty in Older Adults: Evidence for a Phenotype","volume":"56","author":"Fried","year":"2001","journal-title":"J. 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Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1097\/00000421-198212000-00014","article-title":"Toxicity and Response Criteria of the Eastern Cooperative Oncology Group","volume":"5","author":"Oken","year":"1982","journal-title":"Am. J. Clin. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1016\/j.clon.2020.06.016","article-title":"Beyond Performance Status","volume":"32","author":"Simcock","year":"2020","journal-title":"Clin. Oncol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1093\/annonc\/mdu540","article-title":"The Prevalence and Outcomes of Frailty in Older Cancer Patients: A Systematic Review","volume":"26","author":"Handforth","year":"2015","journal-title":"Ann. Oncol."},{"key":"ref_9","first-page":"362","article-title":"Frailty and Cancer: Implications for Oncology Surgery, Medical Oncology, and Radiation Oncology","volume":"67","author":"Ethun","year":"2017","journal-title":"CA Cancer J. Clin."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e617","DOI":"10.1016\/S2666-7568(22)00169-6","article-title":"Integrated Geriatric Assessment and Treatment Effectiveness (INTEGERATE) in Older People with Cancer Starting Systemic Anticancer Treatment in Australia: A Multicentre, Open-Label, Randomised Controlled Trial","volume":"3","author":"Soo","year":"2022","journal-title":"Lancet Healthy Longev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1093\/gerona\/50A.Special_Issue.5","article-title":"What Is Sarcopenia?","volume":"50","author":"Evans","year":"1995","journal-title":"J. Gerontol. Ser. A Biol. Sci. Med. Sci."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1093\/ajcn\/66.4.760","article-title":"Anorexia of Aging: Physiologic and Pathologic","volume":"66","author":"Je","year":"1997","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_13","first-page":"1422","article-title":"Sarcopenia in Chronic Liver Disease: Impact on Outcomes","volume":"25","author":"Ooi","year":"2019","journal-title":"Liver Transplant. Off. Publ. Am. Assoc. Study Liver Dis. Int. Liver Transplant. Soc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1016\/j.jhep.2021.11.006","article-title":"Effect of Sarcopenia on Survival in Patients with Cirrhosis: A Meta-Analysis","volume":"76","author":"Tantai","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1016\/j.jhep.2023.03.025","article-title":"Liver Transplantation in the Patient with Physical Frailty","volume":"78","author":"Tandon","year":"2023","journal-title":"J. Hepatol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1111\/ctr.12493","article-title":"Relationship between Sarcopenia, Six-Minute Walk Distance and Health-Related Quality of Life in Liver Transplant Candidates","volume":"29","author":"Yadav","year":"2015","journal-title":"Clin. Transplant."},{"key":"ref_17","first-page":"1480","article-title":"Handgrip Strength Adds More Prognostic Value to the Model for End-Stage Liver Disease Score Than Imaging-Based Measures of Muscle Mass in Men with Cirrhosis","volume":"25","author":"Sinclair","year":"2019","journal-title":"Liver Transplant. Off. Publ. Am. Assoc. Study Liver Dis. Int. Liver Transplant. 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Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3103","DOI":"10.1111\/j.1582-4934.2009.00733.x","article-title":"Inflammation and Frailty Measures in Older People","volume":"13","author":"Hubbard","year":"2009","journal-title":"J. Cell. Mol. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1768","DOI":"10.1038\/ajg.2016.336","article-title":"Frailty as Tested by Gait Speed Is an Independent Risk Factor for Cirrhosis Complications That Require Hospitalization","volume":"111","author":"Dunn","year":"2016","journal-title":"Am. J. Gastroenterol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1002\/hep.29219","article-title":"Development of a Novel Frailty Index to Predict Mortality in Patients with End-Stage Liver Disease","volume":"66","author":"Lai","year":"2017","journal-title":"Hepatology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1759","DOI":"10.1038\/ajg.2016.303","article-title":"A Rapid Bedside Screen to Predict Unplanned Hospitalization and Death in Outpatients with Cirrhosis: A Prospective Evaluation of the Clinical Frailty Scale","volume":"111","author":"Tandon","year":"2016","journal-title":"Off. J. Am. Coll. Gastroenterol. ACG"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/j.jceh.2021.07.003","article-title":"A Comparison of Different Frailty Scores and Impact of Frailty on Outcome in Patients with Cirrhosis","volume":"12","author":"Singh","year":"2022","journal-title":"J. Clin. Exp. Hepatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1217","DOI":"10.21037\/atm-20-943","article-title":"A Self-Reported Frailty Index Predicts Long-Term Mortality in Hospitalized Patients with Cirrhosis","volume":"8","author":"Deng","year":"2020","journal-title":"Ann. Transl. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e00211","DOI":"10.14309\/ctg.0000000000000211","article-title":"Validation of the Clinical Frailty Scale for the Prediction of Mortality in Patients with Liver Cirrhosis","volume":"11","author":"Kremer","year":"2020","journal-title":"Clin. Transl. Gastroenterol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1002\/hep.32157","article-title":"Frailty Is Associated with Increased Risk of Cirrhosis Disease Progression and Death","volume":"75","author":"Wang","year":"2022","journal-title":"Hepatology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1711","DOI":"10.1002\/lt.26100","article-title":"Inpatient Frailty Assessment Is Feasible and Predicts Nonhome Discharge and Mortality in Decompensated Cirrhosis","volume":"27","author":"Serper","year":"2021","journal-title":"Liver Transpl."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"584","DOI":"10.1002\/hep.27830","article-title":"Standard Assessments of Frailty Are Validated Predictors of Mortality in Hospitalized Patients with Cirrhosis","volume":"62","author":"Tapper","year":"2015","journal-title":"Hepatology"},{"key":"ref_31","first-page":"2117","article-title":"Frailty in Advanced Liver Disease","volume":"38","author":"Laube","year":"2018","journal-title":"Liver Int. 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Hepatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1676","DOI":"10.1002\/hep.30336","article-title":"Frailty, Psychoactive Medications, and Cognitive Dysfunction Are Associated with Poor Patient-Reported Outcomes in Cirrhosis","volume":"69","author":"Tapper","year":"2019","journal-title":"Hepatology"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1007\/s11011-012-9364-0","article-title":"Depression, Anxiety and Alexithymia Symptoms Are Major Determinants of Health Related Quality of Life (HRQoL) in Cirrhotic Patients","volume":"28","author":"Nardelli","year":"2013","journal-title":"Metab. Brain Dis."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Gazineo, D., Godino, L., Bui, V., El Mouttaqi, L., Franciosi, E., Natalino, A., Ceci, G., and Ambrosi, E. (2021). Health-Related Quality of Life in Outpatients with Chronic Liver Disease: A Cross-Sectional Study. BMC Gastroenterol., 21.","DOI":"10.1186\/s12876-021-01890-7"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1053\/gast.2001.21193","article-title":"Factors Associated with Poor Health-Related Quality of Life of Patients with Cirrhosis","volume":"120","author":"Marchesini","year":"2001","journal-title":"Gastroenterology"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"426","DOI":"10.1016\/j.jamda.2016.01.019","article-title":"A Multicomponent Exercise Intervention That Reverses Frailty and Improves Cognition, Emotion, and Social Networking in the Community-Dwelling Frail Elderly: A Randomized Clinical Trial","volume":"17","author":"Cabo","year":"2016","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1225","DOI":"10.1016\/j.amjmed.2015.06.017","article-title":"Nutritional, Physical, Cognitive, and Combination Interventions and Frailty Reversal Among Older Adults: A Randomized Controlled Trial","volume":"128","author":"Ng","year":"2015","journal-title":"Am. J. Med."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"European Association for the Study of the Liver (2019). EASL Clinical Practice Guidelines on Nutrition in Chronic Liver Disease. J. Hepatol., 70, 172\u2013193.","DOI":"10.1016\/j.jhep.2018.06.024"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"M85","DOI":"10.1093\/geronj\/49.2.M85","article-title":"A Short Physical Performance Battery Assessing Lower Extremity Function: Association with Self-Reported Disability and Prediction of Mortality and Nursing Home Admission","volume":"49","author":"Guralnik","year":"1994","journal-title":"J. Gerontol."},{"key":"ref_42","unstructured":"(2025, September 30). Liver Frailty Index. Available online: https:\/\/liverfrailtyindex.ucsf.edu\/."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"966","DOI":"10.1016\/j.ajt.2023.04.012","article-title":"The Tele-Liver Frailty Index (TeLeFI): Development of a Novel Frailty Tool in Patients with Cirrhosis via Telemedicine","volume":"23","author":"Wang","year":"2023","journal-title":"Am. J. Transplant. Off. J. Am. Soc. Transplant. Am. Soc. Transpl. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1986","DOI":"10.1111\/ajt.14675","article-title":"Physical Frailty after Liver Transplantation","volume":"18","author":"Lai","year":"2018","journal-title":"Am. J. Transplant. Off. J. Am. Soc. Transplant. Am. Soc. Transpl. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1038\/ajg.2017.443","article-title":"The Liver Frailty Index Improves Mortality Prediction of the Subjective Clinician Assessment in Patients with Cirrhosis","volume":"113","author":"Lai","year":"2018","journal-title":"Am. J. Gastroenterol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e651","DOI":"10.1097\/TXD.0000000000001097","article-title":"Evaluating the Associations Between the Liver Frailty Index and Karnofsky Performance Status with Waitlist Mortality","volume":"7","author":"Xu","year":"2021","journal-title":"Transplant. Direct"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/j.jhep.2020.03.029","article-title":"Changes in Frailty Are Associated with Waitlist Mortality in Patients with Cirrhosis","volume":"73","author":"Lai","year":"2020","journal-title":"J. Hepatol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1002\/hep.32268","article-title":"Frailty, Mortality, and Health Care Utilization after Liver Transplantation: From the Multicenter Functional Assessment in Liver Transplantation (FrAILT) Study","volume":"75","author":"Lai","year":"2022","journal-title":"Hepatology"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1001\/jamasurg.2022.6387","article-title":"Association of Frailty with Health-Related Quality of Life in Liver Transplant Recipients","volume":"158","author":"Lai","year":"2023","journal-title":"JAMA Surg."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1093\/ageing\/afu157","article-title":"Diagnostic Test Accuracy of Simple Instruments for Identifying Frailty in Community-Dwelling Older People: A Systematic Review","volume":"44","author":"Clegg","year":"2015","journal-title":"Age Ageing"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.jhep.2024.08.028","article-title":"EASL Clinical Practice Guidelines on the Management of Hepatocellular Carcinoma","volume":"82","author":"Sangro","year":"2025","journal-title":"J. Hepatol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1922","DOI":"10.1097\/HEP.0000000000000466","article-title":"AASLD Practice Guidance on Prevention, Diagnosis, and Treatment of Hepatocellular Carcinoma","volume":"78","author":"Singal","year":"2023","journal-title":"Hepatology"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"681","DOI":"10.1016\/j.jhep.2021.11.018","article-title":"BCLC Strategy for Prognosis Prediction and Treatment Recommendation: The 2022 Update","volume":"76","author":"Reig","year":"2022","journal-title":"J. Hepatol."},{"key":"ref_54","doi-asserted-by":"crossref","unstructured":"Ramai, D., Dang-Ho, K.P., Kewalramani, A., Bandaru, P., Sacco, R., Giacomelli, L., Shah, A., Papa, S., Cappellini, F., and Perversi, F. (2021). Hospital Frailty Risk Score Is Independently Associated with Mortality and Encephalopathy in Hospitalized Patients with Hepatocellular Carcinoma. Biomedicines, 9.","DOI":"10.3390\/biomedicines9111693"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1295","DOI":"10.21037\/apm-23-332","article-title":"Hepatocellular Carcinoma and Sarcopenia: A Narrative Review","volume":"12","author":"Revoredo","year":"2023","journal-title":"Ann. Palliat. Med."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Marasco, G., Dajti, E., Serenari, M., Alemanni, L.V., Ravaioli, F., Ravaioli, M., Vestito, A., Vara, G., Festi, D., and Golfieri, R. (2022). Sarcopenia Predicts Major Complications after Resection for Primary Hepatocellular Carcinoma in Compensated Cirrhosis. Cancers, 14.","DOI":"10.3390\/cancers14081935"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1111\/hepr.13453","article-title":"Clinical Utility of the Liver Frailty Index for Predicting Muscle Atrophy in Chronic Liver Disease Patients with Hepatocellular Carcinoma","volume":"50","author":"Hirota","year":"2020","journal-title":"Hepatol. Res. Off. J. Jpn. Soc. Hepatol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"e312","DOI":"10.1016\/S1470-2045(23)00186-9","article-title":"Personalised Management of Patients with Hepatocellular Carcinoma: A Multiparametric Therapeutic Hierarchy Concept","volume":"24","author":"Vitale","year":"2023","journal-title":"Lancet Oncol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"2206","DOI":"10.1002\/hep.31187","article-title":"Treatment of Hepatocellular Carcinoma in the Precision Medicine Era: From Treatment Stage Migration to Therapeutic Hierarchy","volume":"72","author":"Vitale","year":"2020","journal-title":"Hepatology"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"21","DOI":"10.20517\/2394-5079.2025.13","article-title":"The Importance of Patient Fitness in Expert and Multidisciplinary Multiparametric Management of HCC: A Narrative Review","volume":"11","author":"Masarone","year":"2025","journal-title":"Hepatoma Res."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"e13746","DOI":"10.1111\/ctr.13746","article-title":"Standardized Measures of Frailty Predict Hospital Length of Stay Following Orthotopic Liver Transplantation for Hepatocellular Carcinoma","volume":"33","author":"DeMaria","year":"2019","journal-title":"Clin. Transplant."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1245\/s10434-020-08742-w","article-title":"Significance of Frailty in Prognosis After Hepatectomy for Elderly Patients with Hepatocellular Carcinoma","volume":"28","author":"Yamada","year":"2021","journal-title":"Ann. Surg. Oncol."},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Tsuchihashi, J., Koya, S., Hirota, K., Koga, N., Narao, H., Tomita, M., Kawaguchi, T., Hashida, R., Nakano, D., and Tsutsumi, T. (2021). Effects of In-Hospital Exercise on Frailty in Patients with Hepatocellular Carcinoma. Cancers, 13.","DOI":"10.3390\/cancers13020194"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.asjsur.2023.05.139","article-title":"Impact of Frailty on Long-Term Outcomes after Liver Resection for Hepatocellular Carcinoma in Elderly Patients: A Prospective Study","volume":"47","author":"Okada","year":"2024","journal-title":"Asian J. Surg."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"102045","DOI":"10.1016\/j.jgo.2024.102045","article-title":"Association between Frailty and Overall Survival among Older Adults with Hepatocellular Carcinoma","volume":"15","author":"Ozluk","year":"2024","journal-title":"J. Geriatr. Oncol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"zrae171","DOI":"10.1093\/bjsopen\/zrae171","article-title":"Association of Preoperative Frailty with Short- and Long-Term Outcomes after Hepatic Resection for Elderly Patients with Hepatocellular Carcinoma: Multicentre Analysis","volume":"9","author":"Diao","year":"2024","journal-title":"BJS Open"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"e00854","DOI":"10.14309\/ctg.0000000000000854","article-title":"Physical Function as Assessed by the Liver Frailty Index Remains Stable Over Time in Patients with Hepatocellular Carcinoma Treated with Locoregional Therapies","volume":"16","author":"Hu","year":"2025","journal-title":"Clin. Transl. Gastroenterol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"12746","DOI":"10.1038\/s41598-025-98043-7","article-title":"Impact of Frailty on the Long-Term Prognosis of the Elderly with Hepatocellular Carcinoma Treated with Transarterial Chemoembolization","volume":"15","author":"Shao","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Jutras, G., Far, A., Wang, M., Li, M., Ge, J., and Lai, J.C. (2025). Tumor Burden and Frailty: No Association in Liver Transplant Candidates with Hepatocellular Carcinoma. Liver Transplant. Off. Publ. Am. Assoc. Study Liver Dis. Int. Liver Transplant. Soc.","DOI":"10.1097\/LVT.0000000000000716"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.jss.2013.01.021","article-title":"Accumulating Deficits Model of Frailty and Postoperative Mortality and Morbidity: Its Application to a National Database","volume":"183","author":"Velanovich","year":"2013","journal-title":"J. Surg. Res."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1002\/bjs5.22","article-title":"Systematic Review and Meta-Analysis of Frailty as a Predictor of Morbidity and Mortality after Major Abdominal Surgery","volume":"1","author":"Sandini","year":"2017","journal-title":"BJS Open"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1001\/jamasurg.2016.4219","article-title":"Association of a Frailty Screening Initiative with Postoperative Survival at 30, 180, and 365 Days","volume":"152","author":"Hall","year":"2017","journal-title":"JAMA Surg."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.1097\/SLA.0000000000003207","article-title":"Multicenter Study of Age, Frailty, and Waitlist Mortality Among Liver Transplant Candidates","volume":"271","author":"Haugen","year":"2020","journal-title":"Ann. Surg."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"e90","DOI":"10.1016\/S1470-2045(24)00404-2","article-title":"Management of Immune Checkpoint Inhibitor-Associated Toxicities in Older Adults with Cancer: Recommendations from the International Society of Geriatric Oncology (SIOG)","volume":"26","author":"Eochagain","year":"2025","journal-title":"Lancet Oncol."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"12002","DOI":"10.1200\/JCO.2022.40.16_suppl.12002","article-title":"Impact of Age and Frailty on Acute Care Use during Immune Checkpoint Inhibitor (ICI) Treatment: A Population-Based Study","volume":"40","author":"Eng","year":"2022","journal-title":"J. Clin. Oncol."},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Jim\u00e9nez Gal\u00e1n, R., Prado-Mel, E., Alvarez de Sotomayor, M., and Martin, L.A.-K. (2023). Impact of Frailty on Outcomes of First-Line Pembrolizumab Monotherapy in a Real-World Population with Advanced Non-Small Cell Lung Cancer. Biology, 12.","DOI":"10.3390\/biology12020191"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.1002\/hep.32049","article-title":"Malnutrition, Frailty, and Sarcopenia in Patients with Cirrhosis: 2021 Practice Guidance by the American Association for the Study of Liver Diseases","volume":"74","author":"Lai","year":"2021","journal-title":"Hepatology"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1038\/s41416-024-02748-x","article-title":"The Physical Activity and Cancer Control (PACC) Framework: Update on the Evidence, Guidelines, and Future Research Priorities","volume":"131","author":"Yang","year":"2024","journal-title":"Br. J. Cancer"},{"key":"ref_79","first-page":"149","article-title":"A Systematic Review of Rehabilitation and Exercise Recommendations in Oncology Guidelines","volume":"71","author":"Stout","year":"2021","journal-title":"CA Cancer J. Clin."},{"key":"ref_80","doi-asserted-by":"crossref","unstructured":"Christopher, C.N., Kang, D.-W., Wilson, R.L., Gonzalo-Encabo, P., Ficarra, S., Heislein, D., and Dieli-Conwright, C.M. (2023). Exercise and Nutrition Interventions for Prehabilitation in Hepato-Pancreato-Biliary Cancers: A Narrative Review. 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