Farag Sheima, van Coevorden Frits, Sneekes Esther, Grunhagen Dirk J, Reyners Anna K L, Boonstra Pieter A, van der Graaf Winette T, Gelderblom Hans J, Steeghs Neeltje
Netherlands Cancer Institute / Antoni van Leeuwenhoek Hospital, Department of Medical Oncology, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
Netherlands Cancer Institute / Antoni van Leeuwenhoek Hospital, Department of Surgical Oncology, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
Eur J Cancer. 2017 Nov;86:318-325. doi: 10.1016/j.ejca.2017.09.017. Epub 2017 Oct 23.
Although gastrointestinal stromal tumours (GIST) predominantly occur in older patients, data on treatment patterns in elderly GIST patients are scarce.
Patients registered in the Dutch GIST Registry (DGR) from January 2009 until December 2016 were included. Differences in treatment patterns between elderly (≥75 years) and younger patients were compared. Multivariate analyses were conducted using logistic regression.
Data of 145 elderly and 665 non-elderly patients were registered (median age 78 and 60 years respectively). In elderly patients, performance score (WHO-PS) and age-adjusted Charlson comorbidity index (ACCI) were significantly higher (p < 0.05; p < 0.001), and albumin level significantly lower (p = 0.04). Hundred-and-nine (75.2%) elderly and 503 (75.6%) non-elderly patients had only localised disease. Surgery was performed in 57% of elderly versus 84% of non-elderly patients (p = 0.003, OR: 0.26, 95% CI: 0.11-0.63). No differences in surgery outcome or complications were found. Thirty-eight percent of elderly with an indication for adjuvant treatment did receive imatinib versus 68% of non-elderly (p = 0.04, OR: 0.47, 95% CI: 0.23-0.95). Thirty-six elderly and 162 non-elderly patients had metastatic disease. Palliative imatinib was equally given (mean dose 400 mg) and adverse events were mostly minor (p = 0.71). In elderly, drug-related toxicity was in 32.7% reason to discontinue imatinib versus 5.1% in non-elderly (p = 0.001, OR 13.5, 95% CI: 2.8-65.0). Median progression-free survival (PFS) was 24 months in elderly and 33 months in non-elderly (p = 0.10). Median overall survival (OS) was 34 months and 59 months respectively (p = 0.01).
Elderly GIST patients with localised disease receive less surgery and adjuvant treatment, irrespective of comorbidity and performance score. Drug-related toxicity results more often in treatment discontinuation. This possibly results in poor outcome.
尽管胃肠道间质瘤（GIST）主要发生于老年患者，但关于老年GIST患者治疗模式的数据却很匮乏。
纳入2009年1月至2016年12月在荷兰胃肠道间质瘤登记处（DGR）登记的患者。比较老年（≥75岁）和年轻患者治疗模式的差异。采用逻辑回归进行多变量分析。
登记了145例老年患者和665例非老年患者的数据（中位年龄分别为78岁和60岁）。老年患者的体能状态评分（WHO-PS）和年龄校正的Charlson合并症指数（ACCI）显著更高（p<0.05；p<0.001），而白蛋白水平显著更低（p=0.04）。109例（75.2%）老年患者和503例（75.6%）非老年患者仅有局限性疾病。57%的老年患者接受了手术，而非老年患者为84%（p=0.003，OR：0.26，95%CI：0.11-0.63）。未发现手术结果或并发症存在差异。有辅助治疗指征的老年患者中38%接受了伊马替尼治疗，而非老年患者为68%（p=0.04，OR：0.47，95%CI：0.23-0.95）。36例老年患者和162例非老年患者有转移性疾病。姑息性伊马替尼的给药剂量相同（平均剂量400mg），不良事件大多较轻微（p=0.71）。在老年患者中，32.7%因药物相关毒性而停用伊马替尼，而非老年患者为5.1%（p=0.001，OR 13.5，95%CI：2.8-65.0）。老年患者的中位无进展生存期（PFS）为24个月，非老年患者为33个月（p=0.10）。中位总生存期（OS）分别为34个月和59个月（p=0.01）。
患有局限性疾病的老年GIST患者接受的手术和辅助治疗较少，无论其合并症和体能状态评分如何。药物相关毒性更常导致治疗中断。这可能导致预后不良。
