综合老年评估预测胃肠道癌症患者术后并发症：一项荟萃分析。

BACKGROUND: Gastrointestinal cancer is an age-associated disease, and geriatric patients are mostly likely to suffer from postoperative complications. Some studies indicated that comprehensive geriatric assessment (CGA) could predict postoperative complications in gastrointestinal cancer patients. However, the evidence is mixed. OBJECTIVE: This study aimed to conduct a meta-analysis to identify the effectiveness of CGA for predicting postoperative complications in gastrointestinal cancer patients. METHODS: The Joanna Briggs Institute Library, Cochrane Library, PubMed, Embase, Web of Science, CINAHL Complete and four Chinese databases were searched for studies published up to March 2017. Two reviewers independently screened literature, extracted data and assessed the quality of included studies. RevMan5.3 was used for meta-analysis or only descriptive analysis. RESULTS: Six studies were included, with 1,037 participants in total. In all, 13 components of CGA were identified, among which comorbidity (Charlson Comorbidity Index [CCI] ≥3; odds ratio [OR]=1.31, 95% CI [1.06, 1.63], =0.01), polypharmacy (≥5 drugs/day; OR=1.30, 95% CI [1.04, 1.61], =0.02) and activities of daily living (ADL) dependency (OR=1.69, 95% CI [1.20, 2.38], =0.003) were proven relevant to the prediction of postoperative complications. No conclusive relationship was established between instrumental activities of daily living (IADL) dependency (OR=1.18, 95% CI [0.73, 1.91], =0.51), Mini-Mental State Examination (MMSE; OR=1.13, 95% CI [0.91, 1.41], =0.27), potential malnutrition (OR=1.07, 95% CI [0.87, 1.31], =0.54), malnutrition (OR=1.26, 95% CI [0.80, 1.99], =0.32), Geriatric Depression Scale (GDS; OR=1.18, 95% CI [0.90, 1.55], =0.24) and postoperative complications. CONCLUSION: Comorbidity (CCI ≥3), polypharmacy (≥5 drugs/day) and ADL dependency were predictive factors for postoperative complications in gastrointestinal cancer patients; the results of other geriatric instruments were not conclusive, pointing to insufficient studies and requirement of more original investigations.

背景：胃肠道癌症是一种与年龄相关的疾病，老年患者更有可能出现术后并发症。一些研究表明，综合老年评估（CGA）可以预测胃肠道癌症患者的术后并发症。然而，证据不一。

目的：本研究旨在进行荟萃分析，以确定 CGA 预测胃肠道癌症患者术后并发症的有效性。

方法：检索 Joanna Briggs 研究所图书馆、考科兰图书馆、PubMed、Embase、Web of Science、CINAHL Complete 和四个中文数据库，检索截至 2017 年 3 月的研究。两名审查员独立筛选文献、提取数据并评估纳入研究的质量。RevMan5.3 用于荟萃分析或仅进行描述性分析。

结果：纳入 6 项研究，共 1037 名参与者。共确定了 13 项 CGA 组成部分，其中合并症（Charlson 合并症指数[CCI]≥3；比值比[OR]=1.31，95%CI[1.06，1.63]，=0.01）、多药治疗（≥5 种药物/天；OR=1.30，95%CI[1.04，1.61]，=0.02）和日常生活活动（ADL）依赖（OR=1.69，95%CI[1.20，2.38]，=0.003）与术后并发症的预测相关。无结论性关系建立在工具性日常生活活动（IADL）依赖（OR=1.18，95%CI[0.73，1.91]，=0.51）、简易精神状态检查（MMSE；OR=1.13，95%CI[0.91，1.41]，=0.27）、潜在营养不良（OR=1.07，95%CI[0.87，1.31]，=0.54）、营养不良（OR=1.26，95%CI[0.80，1.99]，=0.32）、老年抑郁量表（GDS；OR=1.18，95%CI[0.90，1.55]，=0.24）和术后并发症之间。

结论：合并症（CCI≥3）、多药治疗（≥5 种药物/天）和 ADL 依赖是胃肠道癌症患者术后并发症的预测因素；其他老年评估工具的结果没有定论，表明研究不足，需要更多的原始研究。