Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Italy; IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
Department of Internal Medicine and Medical Specialties (DiMI), University of Genoa, Italy; Memorial Sloan Kettering Cancer Center, New York, USA.
J Geriatr Oncol. 2020 May;11(4):610-616. doi: 10.1016/j.jgo.2019.10.018. Epub 2019 Nov 6.
More than 60% of the new cancer diagnoses are currently made in older adults, a highly heterogeneous population. Reliable and time-saving tools to define older adults' prognosis are needed to inform the oncologist's decisions in routine clinical practice. We sought to define a multi-domain classification tool for the prediction of all-cause one-year mortality in a cohort of older adults with solid tumors.
We conducted a single-centre, prospective study of patients with solid cancer aged 65 or older and with G8 score ≤ 14. All patients underwent a comprehensive geriatric assessment (CGA) before starting their surgical or medical treatment. One-year mortality was recorded. A CGA-based prediction tool of one-year mortality was developed and subsequently validated in two independent training and testing cohorts with a 70/30 split, respectively.
162 patients were enrolled. Mean patient age was 78 ± 5.5 years. Forty-three percent of the patients were men. Colorectal and breast cancer were the most common diagnoses. The clinical variables selected for the development of the new classifier (MetaGENUA®) were: mini-nutritional assessment (MNA), instrumental day life activities (IADL), Cumulative Illness Rating Scale (CIRS), geriatric depression scale (GDS), age, and cancer stage. In our independent validation cohort, MetaGENUA® showed high specificity (0.86) and AUC = 0.71 (95% CI = 0.55-0.87).
MetaGENUA® predicts one-year mortality in older patients with cancer with high specificity. As such, MetaGENUA® is predicted to reveal as a useful tool to guide the oncologist's decisions in clinical practice.
目前，超过 60%的癌症新诊断发生在老年人中，这是一个高度异质的人群。为了在常规临床实践中为肿瘤医生的决策提供信息，需要可靠且节省时间的工具来定义老年人的预后。我们旨在为老年实体瘤患者定义一种多领域分类工具，以预测所有原因的一年死亡率。
我们进行了一项单中心、前瞻性研究，纳入了年龄在 65 岁及以上且 G8 评分≤14 的老年实体瘤患者。所有患者在开始手术或药物治疗前都接受了全面的老年评估（CGA）。建立了基于 CGA 的一年死亡率预测工具，并在两个独立的训练和测试队列中进行了验证，分别采用 70/30 分割。
共纳入 162 名患者。患者平均年龄为 78±5.5 岁。43%的患者为男性。最常见的诊断是结直肠癌和乳腺癌。为开发新的分类器（MetaGENUA®）选择的临床变量包括：微型营养评估（MNA）、工具性日常生活活动（IADL）、累积疾病评分量表（CIRS）、老年抑郁量表（GDS）、年龄和癌症分期。在我们的独立验证队列中，MetaGENUA®表现出高特异性（0.86）和 AUC=0.71（95%CI=0.55-0.87）。
MetaGENUA®对癌症老年患者的一年死亡率具有较高的特异性。因此，MetaGENUA®有望成为指导肿瘤医生在临床实践中决策的有用工具。
