老年癌症患者脆弱性筛查：ONCODAGE前瞻性多中心队列研究
Screening for vulnerability in older cancer patients: the ONCODAGE Prospective Multicenter Cohort Study.
作者信息
Soubeyran Pierre, Bellera Carine, Goyard Jean, Heitz Damien, Curé Hervé, Rousselot Hubert, Albrand Gilles, Servent Véronique, Jean Olivier Saint, van Praagh Isabelle, Kurtz Jean-Emmanuel, Périn Stéphane, Verhaeghe Jean-Luc, Terret Catherine, Desauw Christophe, Girre Véronique, Mertens Cécile, Mathoulin-Pélissier Simone, Rainfray Muriel
机构信息
Department of Medical Oncology, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France; University of Bordeaux, Bordeaux, France.
Clinical and Epidemiological Research unit, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France; INSERM U897 (Institut national de la santé et de la recherche médicale), CIC1401 (Centre d'investigation clinique), Institut Bergonié, Bordeaux, France.
出版信息
PLoS One. 2014 Dec 11;9(12):e115060. doi: 10.1371/journal.pone.0115060. eCollection 2014.
BACKGROUND
Geriatric Assessment is an appropriate method for identifying older cancer patients at risk of life-threatening events during therapy. Yet, it is underused in practice, mainly because it is time- and resource-consuming. This study aims to identify the best screening tool to identify older cancer patients requiring geriatric assessment by comparing the performance of two short assessment tools the G8 and the Vulnerable Elders Survey (VES-13).
PATIENTS AND METHODS
The diagnostic accuracy of the G8 and the (VES-13) were evaluated in a prospective cohort study of 1674 cancer patients accrued before treatment in 23 health care facilities. 1435 were eligible and evaluable. Outcome measures were multidimensional geriatric assessment (MGA), sensitivity (primary), specificity, negative and positive predictive values and likelihood ratios of the G8 and VES-13, and predictive factors of 1-year survival rate.
RESULTS
Patient median age was 78.2 years (70-98) with a majority of females (69.8%), various types of cancer including 53.9% breast, and 75.8% Performance Status 0-1. Impaired MGA, G8, and VES-13 were 80.2%, 68.4%, and 60.2%, respectively. Mean time to complete G8 or VES-13 was about five minutes. Reproducibility of the two questionnaires was good. G8 appeared more sensitive (76.5% versus 68.7%, P = 0.0046) whereas VES-13 was more specific (74.3% versus 64.4%, P<0.0001). Abnormal G8 score (HR = 2.72), advanced stage (HR = 3.30), male sex (HR = 2.69) and poor Performance Status (HR = 3.28) were independent prognostic factors of 1-year survival.
CONCLUSION
With good sensitivity and independent prognostic value on 1-year survival, the G8 questionnaire is currently one of the best screening tools available to identify older cancer patients requiring geriatric assessment, and we believe it should be implemented broadly in daily practice. Continuous research efforts should be pursued to refine the selection process of older cancer patients before potentially life-threatening therapy.
背景
老年评估是识别在治疗期间有发生危及生命事件风险的老年癌症患者的一种合适方法。然而，在实际应用中它未得到充分利用，主要是因为它耗时且耗费资源。本研究旨在通过比较两种简短评估工具G8和脆弱老年人调查（VES - 13）的性能，确定用于识别需要进行老年评估的老年癌症患者的最佳筛查工具。
患者与方法
在一项对23个医疗机构中1674例治疗前入组的癌症患者进行的前瞻性队列研究中，评估了G8和VES - 13的诊断准确性。1435例符合条件且可评估。结局指标包括多维老年评估（MGA）、G8和VES - 13的敏感性（主要指标）特异性、阴性和阳性预测值以及似然比，以及1年生存率的预测因素。
结果
患者中位年龄为78.2岁（70 - 98岁），大多数为女性（69.8%），患有各种类型癌症，其中乳腺癌占53.9%，75.8%的患者体能状态为0 - 1级。MGA、G8和VES - 13评估结果受损的分别为80.2%、68.4%和60.2%。完成G8或VES - 13评估的平均时间约为5分钟。两份问卷的可重复性良好。G8似乎更敏感（76.5%对68.7%，P = 0.0046），而VES - 13更具特异性（74.3%对64.4%，P<0.0001）。G8评分异常（HR = 2.72）、晚期（HR = 3.30）、男性（HR = 2.69）和体能状态差（HR = 3.28）是1年生存率的独立预后因素。
结论
G8问卷具有良好的敏感性和对1年生存率的独立预后价值，是目前用于识别需要进行老年评估的老年癌症患者的最佳筛查工具之一，我们认为应在日常实践中广泛应用。在可能危及生命的治疗之前，应持续进行研究以完善老年癌症患者的筛选过程。
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