Department of Geriatric Medicine, Diakonessenhuis Utrecht, The Netherlands.
Department of Medical Oncology, Erasmus University Medical Centre - Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands.
Breast. 2014 Feb;23(1):81-7. doi: 10.1016/j.breast.2013.11.004. Epub 2013 Dec 5.
To evaluate the association between baseline comprehensive geriatric assessment (CGA) or the Groningen Frailty Indicator (GFI) and toxicity in elderly metastatic breast cancer (MBC) patients treated with first-line palliative chemotherapy.
MBC patients (≥65 years) were randomized between pegylated liposomal doxorubicine or capecitabine. CGA included instrumental activities of daily living (IADL), cognition using the mini-mental state examination (MMSE), mood using the geriatric depression scale (GDS), comorbidity using the Charlson index, polypharmacy and nutritional status using the body mass index. Frailty on CGA was defined as one or more of the following: IADL ≤ 13, MMSE ≤ 23, GDS ≥ 5, BMI ≤ 20, ≥5 medications or Charlson ≥2. The cut-off for frailty on the GFI was ≥4.
Of the randomized 78 patients (median age 75.5 years, range 65.8-86.8 years), 73 were evaluable for CGA; 52 (71%) had one or more geriatric conditions. Grade 3-4 chemotherapy-related toxicity was experienced by 19% of patients without geriatric conditions compared to 56% of patients with two geriatric conditions and 80% of those with three or more (p = 0.002). Polypharmacy was the only individual factor significantly associated with toxicity (p = 0.001). GFI had a sensitivity of 69% and a specificity of 76% for frailty on CGA, and was not significantly associated with survival or toxicity.
In this study of elderly patients with MBC, the number of geriatric conditions correlated with grade 3-4 chemotherapy-related toxicity. Therefore, in elderly patients for whom chemotherapy is being considered, a CGA could be a useful addition to the decision-making process.
评估基线综合老年评估（CGA）或格罗宁根虚弱指数（GFI）与接受一线姑息化疗的老年转移性乳腺癌（MBC）患者毒性之间的关联。
MBC 患者（≥65 岁）在聚乙二醇脂质体多柔比星或卡培他滨之间随机分组。CGA 包括日常生活活动的工具性（IADL）、使用简易精神状态检查（MMSE）评估认知、使用老年抑郁量表（GDS）评估情绪、使用 Charlson 指数评估合并症、使用药物数量和身体质量指数（BMI）评估药物使用情况和营养状况。CGA 上的虚弱定义为以下一项或多项：IADL≤13、MMSE≤23、GDS≥5、BMI≤20、≥5 种药物或 Charlson≥2。GFI 上的虚弱临界值为≥4。
在随机分配的 78 名患者中（中位年龄 75.5 岁，范围 65.8-86.8 岁），73 名患者可评估 CGA；52 名（71%）有一项或多项老年病。无老年病的患者发生 3-4 级化疗相关毒性的比例为 19%，而有 2 项老年病的患者为 56%，有 3 项或更多老年病的患者为 80%（p=0.002）。药物使用数量是唯一与毒性显著相关的个体因素（p=0.001）。GFI 对 CGA 上的虚弱具有 69%的敏感性和 76%的特异性，与生存或毒性无显著相关性。
在这项针对老年 MBC 患者的研究中，老年病的数量与 3-4 级化疗相关毒性相关。因此，在考虑为老年患者进行化疗时，CGA 可能是决策过程中的有用补充。
