Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Memorial Sloan Kettering Cancer Center, New York, New York.
J Am Acad Dermatol. 2018 Jun;78(6):1119-1124. doi: 10.1016/j.jaad.2017.12.048. Epub 2017 Dec 27.
There is controversy regarding treatment of nonmelanoma skin cancer (NMSC) in very elderly individuals, with some suggesting that this population may not live long enough to benefit from invasive treatments. Tools to assess limited life expectancy (LLE) exist, but performance in the population of very elderly individuals with NMSC has not been well defined.
Define comorbidity scores associated with LLE in very elderly individuals presenting for management of NMSC.
A retrospective review of 488 patients age 85 or older presenting for NMSC management between July 1999 through December 2014 was performed. Comorbidities were scored by using the Adult Comorbidity Evaluation-27 (ACE-27) and age-adjusted Charlson comorbidity index (ACCI). Dates of death, follow-up, and overall survival were determined.
ACE-27 and ACCI scores were associated with overall survival; at scores of 3 and 7+, respectively, both were associated with less than 50% survival at 4 years. Patients who underwent Mohs micrographic surgery survived a median of 20 months longer than patients who did not.
Retrospective study design and referral bias.
ACE-27 and ACCI scores predicted LLE. The cohort presenting for Mohs micrographic surgery had improved survival, despite similar intercohort comorbidity. This suggests that additional factors contributed to survival and that age and comorbidities alone are inadequate for making NMSC treatment decisions in very elderly individuals.
对于非常高龄个体的非黑色素瘤皮肤癌（NMSC）的治疗存在争议，一些人认为该人群可能活不到从侵袭性治疗中获益的时间。存在评估有限预期寿命（LLE）的工具，但尚未很好地定义 NMSC 极高龄人群中的表现。
确定与接受 NMSC 治疗的超高龄个体的 LLE 相关的合并症评分。
对 1999 年 7 月至 2014 年 12 月期间因 NMSC 管理而就诊的 488 名 85 岁或以上的患者进行了回顾性研究。使用成人合并症评估-27（ACE-27）和年龄调整 Charlson 合并症指数（ACCI）对合并症进行评分。确定了死亡、随访和总生存的日期。
ACE-27 和 ACCI 评分与总生存相关；评分分别为 3 和 7+时，两者在 4 年内的生存率均低于 50%。接受 Mohs 显微外科手术的患者的中位生存时间比未接受手术的患者长 20 个月。
回顾性研究设计和转诊偏倚。
ACE-27 和 ACCI 评分预测 LLE。尽管存在相似的组间合并症，但接受 Mohs 显微外科手术的患者的生存率有所提高。这表明生存的其他因素起了作用，而且年龄和合并症本身不足以用于做出非常高龄个体的 NMSC 治疗决策。
