Frailty in Hepatocellular Carcinoma: An Unsettled Clinical Challenge

Frailty is a clinical syndrome originally described in geriatrics but increasingly recognized across multiple medical fields. A wide variety of clinical tools have been developed to identify and quantify frailty in different contexts. 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.