综合老年评估在预测接受免疫化疗的老年 B 细胞淋巴瘤患者早期死亡中的应用。

Application of comprehensive geriatric assessment in predicting early mortality among elder patients with B-cell lymphoma receiving immunochemotherapy.

机构信息

Department of Hematology and Oncology, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan.

Division of Hema-oncology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.

出版信息

Eur J Haematol. 2020 Oct;105(4):399-407. doi: 10.1111/ejh.13457. Epub 2020 Jul 2.

DOI:10.1111/ejh.13457

PMID:32472712

Abstract

OBJECTIVES

Early mortality, defined as death within 120 days after initiated antitumor therapy, is an important issue especially for elder patients with B-cell lymphoma. This study aimed to evaluate the clinical value of comprehensive geriatric assessment (CGA) in early mortality prediction in elderly patients with B-cell lymphoma receiving immunochemotherapy.

METHODS

Seventy-six consecutive patients with newly diagnosed B-cell lymphoma receiving immunochemotherapy from a medical center in Taiwan were prospectively enrolled. Patients were divided into fit (n = 49) and frail (n = 27) groups per pretreatment CGA for early mortality comparison.

RESULTS

The early mortality rate in our patient cohort was 16% (n = 12): from 6% in patients with no CGA domain impairment to 43% in patients with ≥4 CGA domain impairment. The early mortality rate was 6% and 33% in fit and frail patients (odds ratio, 7.67; 95% CI, 1.86-31.6; P = .005), respectively. Frailty was the significant predictor for early mortality in univariate and multivariate analysis.

CONCLUSION

In this study, the number of geriatric domain impairment is positively associated with the early mortality risk in elderly patients with B-cell lymphoma. Therefore, CGA can help clinicians to identify the risk of early mortality in elderly patients and provide alternative treatment.

摘要

目的

早期死亡率（定义为抗肿瘤治疗开始后 120 天内死亡）是一个重要问题，尤其是对于接受 B 细胞淋巴瘤免疫化疗的老年患者。本研究旨在评估综合老年评估（CGA）在预测接受免疫化疗的老年 B 细胞淋巴瘤患者早期死亡率中的临床价值。

方法

前瞻性纳入台湾一家医学中心的 76 例新诊断为 B 细胞淋巴瘤且接受免疫化疗的连续患者。根据预处理 CGA 将患者分为体能良好（n=49）和体弱（n=27）两组，以比较早期死亡率。

结果

本患者队列的早期死亡率为 16%（n=12）：无 CGA 域损伤患者的早期死亡率为 6%，≥4 个 CGA 域损伤患者的早期死亡率为 43%。体能良好和体弱患者的早期死亡率分别为 6%和 33%（优势比，7.67；95%CI，1.86-31.6；P=0.005）。在单因素和多因素分析中，体弱是早期死亡的显著预测因素。