探讨合并症对老年和/或体能状态不佳的非小细胞肺癌患者临床结局的影响。
Impact of comorbidities on clinical outcomes in non-small cell lung cancer patients who are elderly and/or have poor performance status.
机构信息
Department of Medical Oncology, National Cancer Centre Singapore, Singapore.
出版信息
Crit Rev Oncol Hematol. 2010 Oct;76(1):53-60. doi: 10.1016/j.critrevonc.2009.10.005. Epub 2009 Nov 24.
AIM
We evaluated the effect of comorbidities on clinical outcomes in patients with advanced non-small cell lung cancer (NSCLC) who have poor performance status (PS 2/3) and/or are elderly (≥70 years old). SUMMARIZED DESCRIPTION: The impact of age (<70 versus >70), PS, and comorbidity score - Cumulative Illness Rating Scale for Geriatrics (CIRS-G) on treatment response, toxicities, QOL and overall survival (OS) was analyzed using data from a completed phase II trial that randomly assigned patients with advanced NSCLC who had PS 2/3 and/or were aged ≥70 to receive gemcitabine (GEM), vinorelbine (VIN) or docetaxel (DOC).
RESULTS
Data from records of 134 patients accrued during the trial were available for analysis. Eighty-eight patients (66%) were aged ≥70 years. 59 patients (67%) had PS of ECOG 0-2 and 29 patients (33%) had ECOG 3. In those aged ≥70, 53 (60%) had at least one comorbidity rated CIRS-G category 3/4 while those aged <70, 12 (26%) had at least one CIRS-G 3/4 comorbidity. Age, PS, and comorbidity scores had no significant association with PFS and QOL scores changes, although PS had marginal influence on OS (0.05<p<0.10). There was significantly greater hematological toxicities and fatigue in patients who had comorbidities of a severe nature. The presence of comorbidity rated CIRS-G category 4 was significantly associated with lower dose intensity of drugs received with no overall impact on response nor survival. In the multivariate analysis, only older patients retained significance with favorable hazard ratio (HR) of 0.5 for overall survival.
CONCLUSIONS
Presence of comorbidities alone should not deter the oncologist from treating elderly cancer patients with cytotoxics. Patients with severe comorbidities may experience more toxicity and receive less cycles of chemotherapy and early medical intervention to control these comorbidities may mitigate risk of treatment using cytotoxics.
目的
我们评估了合并症对体能状态（PS）2/3 或年龄较大（≥70 岁）的晚期非小细胞肺癌（NSCLC）患者临床结局的影响。
摘要描述
使用一项已完成的Ⅱ期临床试验的数据，分析年龄（＜70 岁与≥70 岁）、PS 和合并症评分-老年累积疾病评分量表（CIRS-G）对治疗反应、毒性、生活质量（QOL）和总生存（OS）的影响。该试验将 PS 2/3 或年龄≥70 岁的晚期 NSCLC 患者随机分配至接受吉西他滨（GEM）、长春瑞滨（VIN）或多西他赛（DOC）治疗。
结果
共有 134 例患者的记录数据可用于分析，其中 88 例（66%）年龄≥70 岁，59 例（67%）PS 为 ECOG 0-2，29 例（33%）PS 为 ECOG 3。≥70 岁的患者中，53 例（60%）至少有一种 CIRS-G 3/4 级合并症，而＜70 岁的患者中，12 例（26%）至少有一种 CIRS-G 3/4 级合并症。年龄、PS 和合并症评分与 PFS 和 QOL 评分变化无显著相关性，但 PS 对 OS 有一定影响（0.05＜p＜0.10）。合并症严重程度较高的患者发生血液学毒性和疲劳的风险显著增加。存在 CIRS-G 4 级合并症与接受的药物剂量强度降低显著相关，但对反应和生存无总体影响。多变量分析中，仅年龄较大的患者保留了显著意义，总生存的优势比（HR）为 0.5。
结论
单纯存在合并症不应阻止肿瘤学家对老年癌症患者使用细胞毒药物治疗。合并症严重的患者可能会经历更多的毒性，接受的化疗周期较少，早期进行医学干预以控制这些合并症可能会降低使用细胞毒药物的治疗风险。
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