Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Division of Geriatric and Palliative Medicine, McGovern Medical School, The University of Texas Health Science Center, Houston, Texas.
Cancer Med. 2019 Jun;8(6):2867-2876. doi: 10.1002/cam4.2157. Epub 2019 Apr 29.
Frailty is a syndrome characterized by weakness, slow gait, weight loss, exhaustion, and low activity. We sought to determine whether frailty was associated with age or stage in newly diagnosed patients with pancreatic ductal adenocarcinoma (PDAC), and determine its association with survival.
Consecutive patients with newly diagnosed PDAC of all stages underwent baseline assessment. Frailty (per Fried criteria) was defined as having three or more abnormalities in: grip strength, gait speed, weight loss, self-reported exhaustion, or self-reported physical activity. Baseline clinicodemographic characteristics, anatomic stage, performance status, and laboratory markers of prognosis were included. The association between baseline characteristics, frailty, and survival was determined. The associations of individual frailty measures with age, stage, comorbidities, and performance status were examined. Body composition was measured from computed tomographic images using SliceOMatic software.
Of 150 patients enrolled, 8 were excluded because they did not have PDAC on final diagnosis. The median age was 65 years (range, 32-89). Seventy-nine patients (55.6%) were sarcopenic, and 36 (25.4%) were frail. Frailty was associated with increasing comorbidities (P = 0.03) and worse performance status (P < 0.01). During follow-up, 79 patients (56%) died. Frailty was significantly associated with death during the follow-up period (P < 0.001) for the entire cohort, including patients with curative (P = 0.038) and palliative (P = 0.003) treatment plans.
Frailty was seen frequently in patients with newly diagnosed PDAC and was not associated with increasing age or more advanced stage. Frailty was a predictor of survival, including patients treated with curative intent.
衰弱是一种以虚弱、步态缓慢、体重减轻、疲惫和低活动度为特征的综合征。我们试图确定衰弱是否与新诊断的胰腺导管腺癌 (PDAC) 患者的年龄或分期有关，并确定其与生存的关系。
连续纳入所有分期的新诊断 PDAC 患者进行基线评估。衰弱（按 Fried 标准）定义为存在以下三个或更多异常：握力、步态速度、体重减轻、自我报告的疲惫或自我报告的体力活动。纳入了基线临床病理特征、解剖分期、体能状态和预后的实验室标志物。确定了基线特征、衰弱与生存之间的关系。检查了个体衰弱指标与年龄、分期、合并症和体能状态的关系。使用 SliceOMatic 软件从 CT 图像测量身体成分。
在纳入的 150 例患者中，有 8 例因最终诊断未患有 PDAC 而被排除。中位年龄为 65 岁（范围，32-89 岁）。79 例（55.6%）患者存在肌肉减少症，36 例（25.4%）患者衰弱。衰弱与合并症增多（P=0.03）和体能状态恶化相关（P<0.01）。随访期间，79 例（56%）患者死亡。在整个队列中，包括接受根治性（P=0.038）和姑息性（P=0.003）治疗计划的患者，衰弱与随访期间的死亡显著相关（P<0.001）。
新诊断的 PDAC 患者中衰弱很常见，与年龄增长或分期更晚无关。衰弱是生存的预测因素，包括接受根治性治疗的患者。
