老年人多发性骨髓瘤的脆弱性：一项对美国退伍军人的研究。

Frailty in Older Adults With Multiple Myeloma: A Study of US Veterans.

机构信息

Washington University School of Medicine, St Louis, MO.

St Louis VA Medical Center, St Louis, MO.

出版信息

JCO Clin Cancer Inform. 2020 Feb;4:117-127. doi: 10.1200/CCI.19.00094.

DOI:10.1200/CCI.19.00094

PMID:32083955

Abstract

PURPOSE

Age-associated cumulative decline across physiologic systems results in a diminished resistance to stressors, including cancer and its treatment, creating a vulnerable state known as frailty. Frailty is associated with increased risk of adverse outcomes in patients with cancer. Identification of frailty in administrative data can allow for assessment of prognosis and facilitate control for confounding variables. The purpose of this study was to assess frailty from claims-based data using the accumulation of deficits approach in veterans with multiple myeloma (MM).

METHODS

From the Veterans Administration Central Cancer Registry, we identified patients who were diagnosed with MM between 1999 and 2014. Using the accumulation of deficits approach, we calculated a Frailty Index (FI) using 31 health-associated deficits and categorized scores into five groups: nonfrail (FI, 0 to 0.1), prefrail (FI, 0.11 to 0.20), mild frailty (FI, 0.21 to 0.30), moderate frailty (FI, 0.31 to 0.40), and severe frailty (FI, > 0.4). We used Cox proportional hazards regression analysis to assess association between FI score and mortality while adjusting for potential confounders.

RESULTS

We calculated an FI for 3,807 veterans age 65 years or older. Among the cohort, 28.7% were classified as nonfrail, 41.3% prefrail, 21.6% mildly frail, 6.6% moderately frail, and 1.7% severely frail. Frailty was strongly associated with mortality independent of age, race, MM treatment, body mass index, or statin use. Higher FI score was associated with higher mortality with hazard ratios of 1.33 (95% CI, 1.21 to 1.47), 1.97 (95% CI, 1.70 to 2.20), 2.86 (95% CI, 2.45 to 3.34), and 3.22 (95% CI, 2.46 to 4.22) for prefrail, mildly frail, moderately frail, and severely frail, respectively.

CONCLUSION

Frailty status is a significant predictor of mortality in older veterans with MM. Assessment of frailty status using the readily available electronic medical records data in administrative data allows for assessment of prognosis.

摘要

目的

随着生理系统的累积衰退，与压力源（包括癌症及其治疗）相关的抵抗力下降，导致易患疾病的脆弱状态，即衰弱。衰弱与癌症患者不良结局的风险增加有关。在管理数据中识别衰弱可以评估预后并促进对混杂变量的控制。本研究旨在使用累积缺陷方法评估多发性骨髓瘤（MM）退伍军人的衰弱情况。

方法

我们从退伍军人事务部中央癌症登记处确定了 1999 年至 2014 年间被诊断为 MM 的患者。使用累积缺陷方法，我们使用 31 种与健康相关的缺陷计算了衰弱指数（FI），并将分数分为五组：非衰弱（FI，0 至 0.1）、衰弱前期（FI，0.11 至 0.20）、轻度衰弱（FI，0.21 至 0.30）、中度衰弱（FI，0.31 至 0.40）和严重衰弱（FI，> 0.4）。我们使用 Cox 比例风险回归分析来评估 FI 评分与死亡率之间的关联，同时调整潜在的混杂因素。

结果

我们计算了 3807 名 65 岁或以上退伍军人的 FI。在队列中，28.7%被归类为非衰弱，41.3%为衰弱前期，21.6%为轻度衰弱，6.6%为中度衰弱，1.7%为严重衰弱。衰弱与死亡率密切相关，独立于年龄、种族、MM 治疗、体重指数或他汀类药物使用。FI 评分越高，死亡率越高，危险比分别为 1.33（95%CI，1.21 至 1.47）、1.97（95%CI，1.70 至 2.20）、2.86（95%CI，2.45 至 3.34）和 3.22（95%CI，2.46 至 4.22），分别为衰弱前期、轻度衰弱、中度衰弱和严重衰弱。