Association of preoperative G8 score with survival, preoperative anemia and vitamin D status in gynecologic cancer patients: 5-year analysis of the Frail-B study

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OBJECTIVE: Frailty, nutritional deficiencies, and anemia frequently coexist in gynecologic cancer and may adversely influence clinical outcomes. This study aimed to evaluate the prognostic value of the G8 geriatric screening tool (G8) for survival outcomes in patients undergoing gynecologic oncology surgery, with postoperative complications and selected modifiable preoperative conditions assessed as secondary outcomes. METHODS: Patients ≥60 years undergoing gynecologic oncology surgery were prospectively screened for frailty between May 2020 - June 2025. Survival was evaluated with Kaplan-Meier curves and Cox regression. Propensity score matching included demographics, comorbidities, and tumor characteristics; matched samples were analyzed using weighted Cox models. RESULTS: Of 257 screened patients, 180 were included (endometrial n = 72, ovarian n = 71, vulvar n = 26, cervical n = 6, vaginal cancer n = 5; mean age 69.6 ± 7.9 years; follow-up 25.1 ± 16.3 months). G8 positive patients (≤14 points) had more comorbidities and were more likely to present with preoperative anemia, hypoalbuminemia, and vitamin D or B12 deficiency. FIGO stages, surgical approach and postoperative complications were comparable. G8 positive patients were less likely to receive standard adjuvant therapy (p = 0.003). In matched analyses, G8 positivity remained significantly associated with reduced progression-free survival (HR: 1.87, 95% CI: 1.01-3.49, p = 0.047) and showed a trend toward worse overall survival (HR: 2.25, 95% CI: 0.98-5.16, p = 0.055). Surgical resection status was the strongest predictor of oncological outcome. CONCLUSIONS: A low preoperative G8 score was associated with reduced progression-free and potentially worse overall survival in older women with gynecologic tumors. The G8 may help identify modifiable factors such as anemia or vitamin D deficiency, while complete tumor resection remained the strongest prognostic factor.

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