多维度合并症与化疗治疗老年转移性结直肠癌患者的生存、毒性和非计划性住院的关联。
Association of multidimensional comorbidities with survival, toxicity, and unplanned hospitalizations in older adults with metastatic colorectal cancer treated with chemotherapy.
机构信息
Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea; Senior Adult Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
Senior Adult Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA; Division of Medical Oncology and Hematology, Department of Internal Medicine, Yonsei Noble Hospital, Seoul, South Korea.
出版信息
J Geriatr Oncol. 2019 Sep;10(5):733-741. doi: 10.1016/j.jgo.2019.02.003. Epub 2019 Feb 11.
BACKGROUND
Studies of older patients with colorectal cancer(CRC) have found inconsistent results about the correlation of various comorbidities with overall survival(OS) and treatment tolerance. To refine our understanding, we evaluated this correlation using the Cumulative Illness Rating Scale-Geriatric(CIRS-G) and heat maps to identify subgroups with the highest impact.
METHODS
We retrospectively reviewed 153 patients aged 65 years and older with stage IV CRC undergoing chemotherapy. We calculated CIRS-G scores, and a Total Risk Score(TRS) derived from a previous heat map study. The association between CIRS-G scores/TRS and OS, unplanned hospitalizations, and chemotoxicity was examined by the Cox proportional hazards model.
RESULTS
Median age was 71 years. Median MAX2 score of chemotherapies was 0.134(0.025-0.231). The most common comorbidities were vascular(79.8%), eye/ear/nose/throat(68%), and respiratory disease(52.4%). Median OS was 25.1 months(95% confidence interval: 21.2-27.6). In univariate analysis, ECOG PS ≥ 2(HR 1.86(1.1-3.17), p = 0.019), poorly differentiated histology(HR 2.03(1.27-3.25), p = 0.003), primary site(rectum vs colon)(HR 0.58 (0.34-0.98), p = 0.04), age at diagnosis(HR per 5y 1.20 (1.04-1.39), p = 0.012), and number of CIRS-G grade 4 comorbidities(HR 1.86 (1.1-3.17), p = 0.019) were associated with OS. In multivariate analysis, the number of CIRS-G grade 4 comorbidities lost significance, although it retained it in the subgroup of patients with colon cancer. Conversely, the TRS was associated with OS in patients with rectal cancer. No association of comorbidity with unplanned hospitalization or chemotoxicity was observed.
CONCLUSIONS
In older adults with metastatic CRC, the number of CIRS-G grade 4 comorbidities was associated with worse OS but no specific CIRS-G category was independently associated with OS, unplanned hospitalization, or toxicities.
背景
对老年结直肠癌（CRC）患者的研究发现，各种合并症与总生存期（OS）和治疗耐受性之间的相关性不一致。为了更深入地了解这一点，我们使用累积疾病评分-老年（CIRS-G）和热图来评估这种相关性，以确定影响最大的亚组。
方法
我们回顾性分析了 153 名年龄在 65 岁及以上、接受 IV 期 CRC 化疗的患者。我们计算了 CIRS-G 评分和来自之前热图研究的总风险评分（TRS）。Cox 比例风险模型用于检查 CIRS-G 评分/TRS 与 OS、非计划性住院和化疗毒性之间的关系。
结果
中位年龄为 71 岁。化疗的最大 MAX2 评分中位数为 0.134（0.025-0.231）。最常见的合并症是血管疾病（79.8%）、眼/耳/鼻/喉疾病（68%）和呼吸系统疾病（52.4%）。中位 OS 为 25.1 个月（95%置信区间：21.2-27.6）。在单因素分析中，ECOG PS≥2（HR 1.86（1.1-3.17），p=0.019）、组织学分化不良（HR 2.03（1.27-3.25），p=0.003）、原发部位（直肠与结肠）（HR 0.58（0.34-0.98），p=0.04）、诊断时年龄（每 5 岁 HR 1.20（1.04-1.39），p=0.012）和 CIRS-G 分级 4 合并症数量（HR 1.86（1.1-3.17），p=0.019）与 OS 相关。在多因素分析中，尽管 CIRS-G 分级 4 合并症数量在结肠癌患者亚组中仍具有统计学意义，但与 OS 无关。相反，TRS 与直肠癌患者的 OS 相关。未观察到合并症与非计划性住院或化疗毒性之间存在关联。
结论
在转移性 CRC 的老年患者中，CIRS-G 分级 4 合并症的数量与较差的 OS 相关，但没有特定的 CIRS-G 类别与 OS、非计划性住院或毒性独立相关。
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