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To assess whether the five-factor modified frailty index (mFI5) can predict adverse post-operative outcomes in patients with epithelial ovarian cancer (EOC) undergoing interval cytoreductive surgery (CRS) and if CT-based body composition parameters are correlated with frailty.

A single-institution, retrospective cohort study of EOC patients undergoing interval CRS was performed. Demographic and clinical data were collected. Body composition was measured on pretreatment CT scans and reported as subcutaneous adipose tissue area (SAT), visceral adipose tissue area (VAT), and skeletal muscle index (SMI). Patients were classified using mFI5 into frail (mFI5 ≥ 2) vs. non-frail (mFI5 0–1) cohorts. Postoperative complications, non-home discharge, body composition parameters, progression-free survival (PFS) and overall survival (OS) were compared between cohorts.

Among 179 patients evaluated, 33 patients (18.4 %) were classified as frail, and 146 (81.5 %) were non-frail. Frail patients had significantly higher rates of comorbidities and lower performance status (p < 0.001), but no difference in postoperative complications or non-home discharge was identified. Patients with frailty were more likely to have a higher VAT and SAT area on CT, while SMI was similar among the two cohorts. No statistically significant difference in PFS or OS was observed among frail and non-frail patients.

Frailty as assessed by mFI5 was identified in 18.4 % of patients undergoing interval CRS in our study and was not associated with non-home discharge, postoperative complications or survival. We identified a potential link between frailty and metabolic dysregulation, represented by higher VAT and SAT on CT scans.