Biganzoli Laura, Mislang Anna Rachelle, Di Donato Samantha, Becheri Dimitri, Biagioni Chiara, Vitale Stefania, Sanna Giuseppina, Zafarana Elena, Gabellini Stefano, Del Monte Francesca, Mori Elena, Pozzessere Daniele, Brunello Antonella, Luciani Andrea, Laera Letizia, Boni Luca, Di Leo Angelo, Mottino Giuseppe
Medical Oncology Department, Nuovo Ospedale-Santo Stefano, Instituto Toscano Tumori, Prato, Italy.
Geriatric Medicine Unit, Nuovo Ospedale-Santo Stefano, Prato, Italy.
J Gerontol A Biol Sci Med Sci. 2017 Jul 1;72(7):922-928. doi: 10.1093/gerona/glw234.
Frailty increases the risk of adverse health outcomes and/or dying when exposed to a stressor, and routine frailty assessment is recommended to guide treatment decision. The Balducci frailty criteria (BFC) and Fried frailty criteria (FFC) are commonly used, but these are time consuming. Vulnerable Elders Survey-13 (VES-13) score of ≥7, a simple and resource conserving function-based scoring system, may be used instead. This prospective study evaluates the performance of VES-13 in parallel with BFC and FFC, to identify frailty in elderly patients with early-stage cancer.
Patients aged ≥70 years with early-stage solid tumors were classified as frail/nonfrail based on BFC (≥1 criteria), FFC (≥3 criteria), and VES-13 (score ≥ 7). All patients were assessed for functional decline and death.
We evaluated 185 patients. FFC had a 17% frailty rate, whereas BFC and VES-13 both had 25%, with poor concordance seen between the three geriatric tools. FFC (hazard ratio = 1.99, p = .003) and VES-13 (hazard ratio = 2.81, p < .001) strongly discriminated for functional decline, whereas BFC (hazard ratio = 3.29, p < .001) had the highest discriminatory rate for deaths. BFC and VES-13 remained prognostic for overall survival in multivariate analysis correcting for age, tumor type, stage, and systemic treatment.
A VES-13 score of ≥7 is a valuable discriminating tool for predicting functional decline or death and can be used as a frailty-screening tool among older cancer patients in centers with limited resources to conduct a comprehensive geriatric assessment.
衰弱会增加暴露于应激源时出现不良健康结局和/或死亡的风险，因此建议进行常规衰弱评估以指导治疗决策。常用的有巴尔杜奇衰弱标准（BFC）和弗里德衰弱标准（FFC），但这些评估耗时较长。可使用易损老年人调查-13（VES-13）评分≥7，这是一种基于功能的简单且资源节约型评分系统。这项前瞻性研究评估了VES-13与BFC和FFC并行的性能，以识别老年早期癌症患者的衰弱情况。
年龄≥70岁的早期实体瘤患者根据BFC（≥1条标准）、FFC（≥3条标准）和VES-13（评分≥7）分为衰弱/非衰弱。所有患者均接受功能衰退和死亡评估。
我们评估了185例患者。FFC的衰弱率为17%，而BFC和VES-13均为25%，这三种老年评估工具之间的一致性较差。FFC（风险比=1.99，p = 0.003）和VES-13（风险比=2.81，p < 0.001）对功能衰退有很强的区分能力，而BFC（风险比=3.29，p < 0.001）对死亡的区分率最高。在对年龄、肿瘤类型、分期和全身治疗进行校正的多变量分析中，BFC和VES-13对总生存期仍具有预后价值。
VES-13评分≥7是预测功能衰退或死亡的有价值的区分工具，可作为资源有限、无法进行全面老年评估的中心对老年癌症患者进行衰弱筛查的工具。
