Department of Geriatric Medicine, Diakonessenhuis, Utrecht, The Netherlands,
Ann Hematol. 2014 Jun;93(6):1031-40. doi: 10.1007/s00277-013-2001-0. Epub 2014 Feb 2.
The G8 screening tool was developed to separate fit older cancer patients who were able to receive standard treatment from those that should undergo a geriatric assessment to guide tailoring of therapy. We set out to determine the discriminative power and prognostic value of the G8 in older patients with a haematological malignancy. Between September 2009 and May 2013, a multi-dimensional geriatric assessment was performed in consecutive patients aged ≥67 years diagnosed with blood cancer at the Innsbruck University Hospital. The assessment included (instrumental) activities of daily living, cognition, mood, nutritional status, mobility, polypharmacy and social support. In parallel, the G8 was also administered (cut-off ≤ 14). Using a cut-off of ≥2 impaired domains, 70 % of the 108 included patients were considered as having an impaired geriatric assessment while 61 % had an impaired G8. The G8 lacked discriminative power for impairments on full geriatric assessment: sensitivity 69, specificity 79, positive predictive value 89 and negative predictive value 50 %. However, G8 was an independent predictor of mortality within the first year after inclusion (hazard ratio 3.93; 95 % confidence interval 1.67-9.22, p < 0.001). Remarkably, patients with impaired G8 fared poorly, irrespective of treatment choices (p < 0.001). This is the first report on the clinical and prognostic relevance of G8 in elderly patients with haematological malignancies. Although the G8 lacked discriminative power for outcome of multi-dimensional geriatric assessment, this score appears to be a powerful prognosticator and could potentially represent a useful tool in treatment decisions. This novel finding certainly deserves further exploration.
G8 筛查工具旨在区分能够接受标准治疗的身体状况良好的老年癌症患者和需要进行老年综合评估以指导治疗方案调整的患者。我们旨在确定 G8 在患有血液恶性肿瘤的老年患者中的区分能力和预后价值。2009 年 9 月至 2013 年 5 月，在因血液癌在因斯布鲁克大学医院就诊的年龄≥67 岁的连续患者中进行了多维老年综合评估。评估包括（工具）日常生活活动、认知、情绪、营养状况、活动能力、多重用药和社会支持。同时，还进行了 G8 评估（截断值≤14）。使用≥2 个受损域的截断值，108 名纳入患者中有 70%被认为存在受损的老年综合评估，而 61%的患者存在受损的 G8。G8 对全面老年综合评估的损伤缺乏区分能力：敏感性 69%，特异性 79%，阳性预测值 89%和阴性预测值 50%。然而，G8 是纳入后第一年死亡的独立预测因素（危险比 3.93；95%置信区间 1.67-9.22，p<0.001）。值得注意的是，无论治疗选择如何，G8 受损的患者预后均较差（p<0.001）。这是 G8 在血液恶性肿瘤老年患者中的临床和预后相关性的首次报告。尽管 G8 对多维老年综合评估的结果缺乏区分能力，但该评分似乎是一种强大的预后指标，可能是治疗决策中的有用工具。这一新颖的发现当然值得进一步探索。
