City of Hope Comprehensive Cancer Center and Beckman Research Institute, Duarte, CA 91010, USA.
J Clin Oncol. 2011 Sep 1;29(25):3457-65. doi: 10.1200/JCO.2011.34.7625. Epub 2011 Aug 1.
Older adults are vulnerable to chemotherapy toxicity; however, there are limited data to identify those at risk. The goals of this study are to identify risk factors for chemotherapy toxicity in older adults and develop a risk stratification schema for chemotherapy toxicity.
Patients age ≥ 65 years with cancer from seven institutions completed a prechemotherapy assessment that captured sociodemographics, tumor/treatment variables, laboratory test results, and geriatric assessment variables (function, comorbidity, cognition, psychological state, social activity/support, and nutritional status). Patients were followed through the chemotherapy course to capture grade 3 (severe), grade 4 (life-threatening or disabling), and grade 5 (death) as defined by the National Cancer Institute Common Terminology Criteria for Adverse Events.
In total, 500 patients with a mean age of 73 years (range, 65 to 91 years) with stage I to IV lung (29%), GI (27%), gynecologic (17%), breast (11%), genitourinary (10%), or other (6%) cancer joined this prospective study. Grade 3 to 5 toxicity occurred in 53% of the patients (39% grade 3, 12% grade 4, 2% grade 5). A predictive model for grade 3 to 5 toxicity was developed that consisted of geriatric assessment variables, laboratory test values, and patient, tumor, and treatment characteristics. A scoring system in which the median risk score was 7 (range, 0 to 19) and risk stratification schema (risk score: percent incidence of grade 3 to 5 toxicity) identified older adults at low (0 to 5 points; 30%), intermediate (6 to 9 points; 52%), or high risk (10 to 19 points; 83%) of chemotherapy toxicity (P < .001).
A risk stratification schema can establish the risk of chemotherapy toxicity in older adults. Geriatric assessment variables independently predicted the risk of toxicity.
老年人易发生化疗毒性；然而，目前仅有有限的数据可用于识别高危人群。本研究旨在明确老年人化疗毒性的危险因素，并制定化疗毒性风险分层方案。
来自 7 家机构的年龄≥65 岁的癌症患者完成了化疗前评估，内容包括社会人口统计学、肿瘤/治疗变量、实验室检查结果以及老年评估变量（功能、合并症、认知、心理状态、社会活动/支持和营养状况）。通过化疗过程对患者进行随访，以记录美国国家癌症研究所不良事件常用术语标准（National Cancer Institute Common Terminology Criteria for Adverse Events）定义的 3 级（严重）、4 级（危及生命或致残）和 5 级（死亡）毒性。
共有 500 例年龄在 65 岁至 91 岁（平均年龄 73 岁）的Ⅰ至Ⅳ期肺癌（29%）、胃肠道肿瘤（27%）、妇科肿瘤（17%）、乳腺癌（11%）、泌尿生殖系统肿瘤（10%）或其他肿瘤（6%）患者参与了这项前瞻性研究。53%的患者发生 3 至 5 级毒性（39%为 3 级，12%为 4 级，2%为 5 级）。我们建立了一个预测 3 至 5 级毒性的模型，包含老年评估变量、实验室检查值以及患者、肿瘤和治疗特征。该模型采用评分系统，中位风险评分为 7 分（范围为 0 至 19 分），风险分层方案（风险评分：3 至 5 级毒性发生率）可识别化疗毒性低危（0 至 5 分；30%）、中危（6 至 9 分；52%）或高危（10 至 19 分；83%）的老年患者（P<0.001）。
风险分层方案可确定老年人化疗毒性的风险。老年评估变量独立预测毒性风险。
