Internal Medicine Research and Care Unit, European Hospital, Marseille, France.
Geriatric Day Hospital Unit, State Geriatric Center, Marseille, France.
Oncologist. 2020 Jan;25(1):e85-e93. doi: 10.1634/theoncologist.2019-0241. Epub 2019 Aug 6.
Older patients with colon cancer (CC) are vulnerable to chemotherapy toxicity and death. Establishing simple scores specific for patients with CC to predict severe chemotoxicity or early death is needed to select the best treatment strategy.
SUBJECTS, MATERIALS, AND METHODS: This prospective multicenter study included patients aged ≥70 years with CC receiving adjuvant or first-line metastatic chemotherapy. Frailty markers (nutrition, physical activity, energy, mobility, strength), comprehensive geriatric assessment (functional status, comorbidities, falls, nutrition, cognition, and depression), and usual laboratory parameters were collected. Logistic or Cox regression was used to examine at 500 days the association between frailty markers, comprehensive geriatric assessment, laboratory parameters, and grade 3-4 toxicity or death.
A total of 97 patients (median age, 79.0 years) received adjuvant (37.1%) or metastatic (62.9%) chemotherapy. During the first 500 days, grade 3-4 toxicity occurred in 49.5%, and 30% died. The predictive model for grade 3-4 toxicity combined (polychemotherapy × 3) + (hypoalbuminemia <32 g/L × 2) + (abnormal grip strength × 1.5) + C-reactive protein >11 mg/L + Eastern Cooperative Oncology Group performance status (ECOG-PS), cutoff score >3. The predictive model for death combined (metastasis × 5) + (age × 2) + alkaline phosphatase >100 IU/mL + sex (female) + abnormal grip strength + ECOG-PS, cutoff score >6. For chemotoxicity prediction, sensitivity was 81.6% and specificity 71.4%. For death prediction, sensitivity was 89.7% and specificity was 83.6%.
These simple and efficient "ColonPrediscores" will help to better identify older patients with CC with increased risk of chemotherapy-related toxicity and/or death.
The two scores assessed in this study, called "ColonPrediscores", offer a major advantage in that they do not need a previous complete geriatric assessment, which makes them an easy-to-use tool in oncologic settings.
老年结肠癌（CC）患者易发生化疗毒性和死亡。因此，需要建立针对 CC 患者的简单评分，以预测严重的化疗毒性或早期死亡，从而选择最佳治疗策略。
对象、材料和方法：这项前瞻性多中心研究纳入了年龄≥70 岁、接受辅助或一线转移性化疗的 CC 患者。收集了脆弱性标志物（营养、体力活动、能量、移动能力、力量）、综合老年评估（功能状态、合并症、跌倒、营养、认知和抑郁）和常规实验室参数。使用逻辑或 Cox 回归分析 500 天内脆弱性标志物、综合老年评估、实验室参数与 3-4 级毒性或死亡之间的相关性。
共纳入 97 例患者（中位年龄 79.0 岁），接受辅助（37.1%）或转移性（62.9%）化疗。在最初的 500 天内，发生 3-4 级毒性的患者有 49.5%，30%的患者死亡。3-4 级毒性的预测模型包括（联合化疗×3）+（低白蛋白血症<32 g/L×2）+（握力异常×1.5）+C 反应蛋白>11 mg/L+东部肿瘤协作组体能状态（ECOG-PS）评分>3。死亡的预测模型包括（转移×5）+（年龄×2）+碱性磷酸酶>100 IU/mL+性别（女）+握力异常+ECOG-PS 评分>6。对于化疗毒性预测，敏感性为 81.6%，特异性为 71.4%。对于死亡预测，敏感性为 89.7%，特异性为 83.6%。
这些简单有效的“ColonPrediscores”有助于更好地识别出老年 CC 患者中化疗相关毒性和/或死亡风险增加的患者。
本研究中评估的两个评分，即“ColonPrediscores”，具有很大的优势，因为它们不需要之前进行全面的老年评估，因此在肿瘤学环境中是一种易于使用的工具。
