血清维生素 B12 水平与老年癌症患者 C 反应蛋白相关。
High Serum Vitamin B12 Levels Associated with C-Reactive Protein in Older Patients with Cancer.
机构信息
Geriatric and Therapeutic Unit, Internal Medicine, Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France.
PACA West Coordination Unit for Geriatric Oncology (UCOG), Marseille, France.
出版信息
Oncologist. 2020 Dec;25(12):e1980-e1989. doi: 10.1634/theoncologist.2019-0894. Epub 2020 Aug 19.
BACKGROUND
A Comprehensive Geriatric Assessment (CGA) has been proposed to assess prognosis and to adapt oncological care in older patients with cancer. However, few biological markers are incorporated in the CGA.
METHODS
This comparative study on older patients with cancer was realized before final therapeutic decision and during a CGA that included biological markers. Our objective study was to know if the serum vitamin B12-C-reactive protein index (BCI) can help to estimate early death and unplanned hospitalization. Associations between BCI and unplanned hospitalization or mortality were analyzed using ordered multivariate logistic regression.
FINDINGS
We included 621 older cancer adults in outpatient care with a median age of 81 years (range, 70-98 years) from September 2015 to May 2018. In this study, 5.6% of patients died within 3 months, 8.8% had unplanned hospitalization within 1 month, and 11.4% had unplanned hospitalization within 3 months. Hypercobalaminemia was present in 83 patients (13.4%), and 34 patients (5.5%) had BCI >40,000. According to the multivariate analysis, BCI was a prognostic factor of mortality within 3 months and unplanned hospitalizations at 1 and 3 months. Impaired activities of daily living (ADL) and palliative care were also risk factors for mortality within 3 months. Impaired instrumental ADL, low albumin level, and palliative care were risk factors for unplanned hospitalization at 1 month.
INTERPRETATION
BCI could be routinely added to the CGA process, as part of a pretreatment workup, in order to assess more precisely the frailties and to adapt oncological care in older patients treated for cancer.
IMPLICATIONS FOR PRACTICE
Aging comes with an increase of frailties and comorbidities. To identify frailties in older patients with cancer, this study used a Comprehensive Geriatric Assessment, which allowed for the adaptation of each treatment plan in accordance with the individual needs of the patients. However, biological characteristics were not included in this assessment. This study showed that hypercobalaminemia and vitamin B12 -C-reactive protein index may be potential markers for cancer with poor prognosis, particularly in the older population. These biological markers can be used in geriatric oncology and general medicine.
背景
全面老年评估（CGA）已被提议用于评估预后，并调整老年癌症患者的肿瘤治疗。然而，该评估并未纳入多少生物标志物。
方法
本研究为比较性研究，纳入了在最终治疗决策前进行 CGA 的老年癌症患者。CGA 中包含了生物标志物，本研究旨在明确血清维生素 B12- C 反应蛋白指数（BCI）是否有助于预测早期死亡和非计划性住院。采用有序多变量逻辑回归分析 BCI 与非计划性住院或死亡率之间的关系。
发现
我们纳入了 2015 年 9 月至 2018 年 5 月在门诊接受治疗的 621 名年龄 70-98 岁（中位年龄 81 岁）的老年癌症患者。研究期间，3 个月内患者的死亡率为 5.6%，1 个月内非计划性住院率为 8.8%，3 个月内非计划性住院率为 11.4%。83 例（13.4%）患者存在高维生素 B12血症，34 例（5.5%）患者的 BCI>40,000。多变量分析显示，BCI 是 3 个月内死亡率和 1 个月、3 个月内非计划性住院的预测因子。日常生活活动（ADL）受损和姑息治疗也是 3 个月内死亡的危险因素。工具性日常生活活动（IADL）受损、低白蛋白水平和姑息治疗是 1 个月内非计划性住院的危险因素。
解释
BCI 可作为 CGA 流程的常规内容，作为治疗前检查的一部分，以便更精确地评估脆弱性并调整老年癌症患者的肿瘤治疗。
意义
随着年龄的增长，机体的脆弱性和合并症增加。为了识别老年癌症患者的脆弱性，本研究采用了全面老年评估，根据患者的个体需求调整了每个治疗计划。然而，该评估并未纳入生物学特征。本研究表明，高维生素 B12血症和维生素 B12 -C 反应蛋白指数可能是预后不良的癌症的潜在标志物，特别是在老年人群中。这些生物标志物可用于老年肿瘤学和普通医学。
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