Department of Geriatric Medicine, Diakonessenhuis Utrecht, Utrecht, Netherlands.
Department of Internal Medicine, Haga Hospital, The Hague, Netherlands.
Clin Lung Cancer. 2017 Nov;18(6):660-666.e1. doi: 10.1016/j.cllc.2017.02.006. Epub 2017 Mar 2.
Because of the time-consuming aspect of geriatric assessments, cancer specialists are seeking shorter screening tools to distinguish fit and frail patients. We analyzed the predictive value of the Geriatric 8 (G8) and Identification of Seniors at Risk for Hospitalized Patients (ISAR-HP) in elderly patients with lung cancer.
From January 2014 to April 2016, the data from patients with lung cancer aged > 70 years at 2 teaching hospitals in the Netherlands were included in a database. The patients were classified as potentially frail if they had a G8 of ≤ 14 or ISAR-HP of ≥ 2.
Of the 142 included patients (median age, 77 years; interquartile range, 73-82 years), 108 (76%) were potentially frail. After correction for possible confounders, the potentially frail patients had a significantly greater risk of 1-year mortality (hazard ratio [HR], 4.08; 95% confidence interval [CI] 1.67-9.99; P = .02). Higher disease stage (HR, 1.72; 95% CI, 1.40-2.12; P < .001) was also a significant predictor of mortality; however, initial treatment (standard or otherwise) and age were not. When using both screening instruments separately, an impaired score on the G8 and higher disease stage were the variables remaining in the regression analyses (HR for impaired G8, 3.01; 95% CI, 1.35-6.72; P < .001). Patients with impaired scores on the ISAR-HP and G8 had more geriatric impairments than did patients with only an impaired G8 score.
G8 screening is useful for the prognostication of elderly patients with lung cancer and could be used in combination with ISAR-HP to increase specificity at the cost of sensitivity. Using the ISAR-HP as the only screening tool would be insufficient.
由于老年评估耗时较长，癌症专家正在寻找更短的筛查工具来区分健康和体弱的患者。我们分析了老年 8 项（G8）和识别高危住院患者（ISAR-HP）在老年肺癌患者中的预测价值。
从 2014 年 1 月至 2016 年 4 月，荷兰 2 所教学医院年龄>70 岁的肺癌患者的数据被纳入数据库。如果患者的 G8 评分≤14 或 ISAR-HP 评分≥2，则被归类为潜在虚弱。
在纳入的 142 例患者中（中位年龄 77 岁；四分位距 73-82 岁），108 例（76%）为潜在虚弱。在纠正可能的混杂因素后，潜在虚弱患者的 1 年死亡率显著更高（风险比 [HR]，4.08；95%置信区间 [CI]，1.67-9.99；P=0.02）。更高的疾病分期（HR，1.72；95% CI，1.40-2.12；P<0.001）也是死亡的显著预测因素；然而，初始治疗（标准或其他）和年龄不是。当分别使用两种筛查工具时，G8 评分受损和更高的疾病分期是回归分析中保留的变量（G8 评分受损的 HR，3.01；95% CI，1.35-6.72；P<0.001）。ISAR-HP 和 G8 评分受损的患者比仅 G8 评分受损的患者有更多的老年障碍。
G8 筛查对老年肺癌患者的预后有帮助，可与 ISAR-HP 联合使用，以牺牲敏感性为代价提高特异性。仅使用 ISAR-HP 作为筛查工具是不够的。
