Hematology Unit, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy.
Department CHIMOMO, University of Modena and Reggio Emilia, Reggio Emilia, Italy.
J Clin Oncol. 2021 Apr 10;39(11):1214-1222. doi: 10.1200/JCO.20.02465. Epub 2021 Feb 12.
To prospectively validate the use of a simplified geriatric assessment (sGA) at diagnosis and to integrate it into a prognostic score for older patients with diffuse large B-cell lymphoma (DLBCL).
We conducted the prospective Elderly Project study on patients with DLBCL older than 64 years who underwent our Fondazione Italiana Linfomi original geriatric assessment (oGA) (age, Cumulative Illness Rating Scale for Geriatrics, activities of daily living, and instrumental activities of daily living) before treatment. Treatment choice was left to the physician's discretion. The primary end point was overall survival (OS) (ClinicalTrials.gov identifier: NCT02364050).
We analyzed 1,163 patients (median age 76 years), with a 3-year OS of 65% (95% CI, 62 to 68). Because at multivariate analysis on oGA, age > 80 years retained an independent correlation with OS, we also developed a new, simplified version of the GA (sGA) that classifies patients as fit (55%), unfit (28%), and frail (18%) with significantly different 3-year OS of 75%, 58%, and 43%, respectively. The sGA groups, International Prognostic Index, and hemoglobin levels were independent predictors of OS and were used to build the Elderly Prognostic Index (EPI). Three risk groups were identified: low (23%), intermediate (48%), and high (29%), with an estimated 3-year OS of 87% (95% CI, 81 to 91), 69% (95% CI, 63 to 73), and 42% (95% CI, 36 to 49), respectively. The EPI was validated using an independent external series of 328 cases.
The Elderly Project validates sGA as an objective tool to assess fitness status and defines the new EPI to predict OS of older patients with DLBCL.
前瞻性验证简化老年评估（sGA）在诊断中的应用，并将其纳入弥漫性大 B 细胞淋巴瘤（DLBCL）老年患者的预后评分。
我们对年龄大于 64 岁且接受我们的意大利淋巴瘤基金会原始老年评估（oGA）的 DLBCL 患者进行了前瞻性老年项目研究（年龄、老年累积疾病评分、日常生活活动和工具性日常生活活动）。治疗选择由医生决定。主要终点是总生存期（OS）（临床试验标识符：NCT02364050）。
我们分析了 1163 例患者（中位年龄 76 岁），3 年 OS 为 65%（95%CI，62 至 68）。由于在 oGA 的多变量分析中，年龄>80 岁与 OS 独立相关，我们还开发了一种新的简化 GA（sGA），该方法将患者分为健康（55%）、不健康（28%）和虚弱（18%），3 年 OS 分别为 75%、58%和 43%。sGA 组、国际预后指数和血红蛋白水平是 OS 的独立预测因子，用于构建老年预后指数（EPI）。确定了 3 个风险组：低危（23%）、中危（48%）和高危（29%），估计 3 年 OS 分别为 87%（95%CI，81 至 91）、69%（95%CI，63 至 73）和 42%（95%CI，36 至 49）。使用 328 例独立的外部系列对 Elderly Project 进行了验证。
Elderly Project 验证了 sGA 作为评估健康状况的客观工具，并定义了新的 EPI 来预测 DLBCL 老年患者的 OS。
