Augschoell Julia, Kemmler Georg, Hamaker Marije E, Stauder Reinhard
Department of Internal Medicine V (Hematology and Oncology), Innsbruck Medical University, Innsbruck, Austria.
Department of Biological Psychiatry, Innsbruck Medical University, Innsbruck, Austria.
J Geriatr Oncol. 2014 Oct 1;5(4):415-21. doi: 10.1016/j.jgo.2014.08.005. Epub 2014 Sep 19.
OBJECTIVES: The multidimensional geriatric assessment (MGA) detects impairments in the elderly and forms the basis for individualized treatment algorithms. Screening tools have been developed to detect patients in need of a full assessment. The aim of this pilot study was to evaluate the discriminative power and the prognostic impact of the screening scores for the Physical Performance Test (PPT) and the Vulnerable Elders Survey-13 (VES-13). MATERIALS AND METHODS: In 77 patients with cancer aged ≥60years (median 74years) from the Department of Internal Medicine V, Innsbruck Medical University, VES-13 and PPT were performed and compared with data from MGA and clinical outcomes. RESULTS: Overall, of the 77 patients 70% was deemed impaired, as defined by impairments in two or more scores of the MGA. The VES-13 showed 42% to be impaired, the PPT 79%. Using a cut-off of ≤19, the PPT exhibited better discriminative power than did the standard PPT (≤20). Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of VES-13, PPT≤20 and PPT≤19 in the detection of impairments were 56% (88%, 82%), 91% (45%, 75%), 94% (80%, 89%), and 45% (60%, 63%) respectively. The area under the curve was 0.73 (0.67, 0.79), respectively. Both impaired VES-13 and PPT significantly correlated with an unfavorable overall survival in both uni- and multivariate analysis. CONCLUSION: PPT (≤19) reveals favorable sensitivity, NPV and overall accuracy in elderly patients with cancer. Still, the NPV is too low to sufficiently discriminate between fit and frail patients. Both PPT and VES-13 are useful predictors for survival.
目的:多维老年评估(MGA)可检测老年人的功能障碍,并为个体化治疗方案提供依据。目前已开发出筛查工具,用于识别需要进行全面评估的患者。本试点研究旨在评估体能测试(PPT)和脆弱老年人调查-13(VES-13)筛查分数的鉴别能力和预后影响。 材料与方法:对因斯布鲁克医科大学内科V的77例年龄≥60岁(中位年龄74岁)的癌症患者进行VES-13和PPT测试,并与MGA数据及临床结局进行比较。 结果:总体而言,77例患者中,70%被判定存在功能障碍,定义为MGA中两项或以上分数存在功能障碍。VES-13显示42%的患者存在功能障碍,PPT显示79%的患者存在功能障碍。以≤19分为临界值时,PPT的鉴别能力优于标准PPT(≤20分)。VES-13、PPT≤20分和PPT≤19分在检测功能障碍方面的敏感性、特异性、阳性预测值(PPV)和阴性预测值(NPV)分别为56%(88%,82%)、91%(45%,75%)、94%(80%,89%)和45%(60%,63%)。曲线下面积分别为0.73(0.67,0.79)。单因素和多因素分析均显示,VES-13和PPT功能障碍均与不良总生存期显著相关。 结论:PPT(≤19分)在老年癌症患者中显示出良好的敏感性、NPV和总体准确性。然而,NPV过低,不足以充分区分健康和虚弱患者。PPT和VES-13都是生存的有用预测指标。
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