Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba, Sendai, Miyagi 980-8574, Japan.
Department of Otolaryngology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan.
J Geriatr Oncol. 2021 Sep;12(7):1039-1043. doi: 10.1016/j.jgo.2021.03.008. Epub 2021 Mar 21.
To clarify the usefulness of geriatric assessment screening tools for predicting prognosis and complications in older adults with head and neck cancer (HNC).
The geriatric-8 (G8) screening tool was administered to 78 older adults with HNC at their first visit to the hospital before any treatments. The ability of the G8 to predict survival was evaluated by receiver operating characteristic (ROC) curve analysis and determining the cut-off value using Youden's Index. The G8 and other factors related to prognosis (age, performance status (PS), Charlson comorbidity index, number of oral medicines (polypharmacy), the controlling nutritional status (CONUT) score for biological nutrition status, and treatment intent (curative or palliative)) were validated by Cox proportional hazards regression analysis. The survival analysis was validated in a propensity score-weighting cohort to correct for confounding factors. Correlations between these factors and complications were examined using Fishers exact test.
The G8 cut-off value for overall survival was 10.5 (area under the curve (AUC) 0.69; 95% confidence interval (CI) 0.56-0.82). In the propensity score-weighted cohort, on Cox proportional hazards regression analysis, the hazard ratio of an abnormal G8 (<11) was 3.70 [1.59-8.61 (p = 0.002)], and the hazard ratio of PS-abnormal (≥2) was 0.85 [0.09-7.60 (p = 0.88)]. Thirty-day mortality and all-complication rates were significantly higher in the G8-abnormal group. Neither major complications nor transfer to other institutions was correlated with an abnormal G8.
The G8 was a strong prognostic factor and a possible predictor of complications in older adults with HNC.
阐明老年综合评估筛查工具在预测头颈部癌症（HNC）老年患者预后和并发症方面的作用。
在 78 例初次就诊的 HNC 老年患者接受任何治疗前，使用老年-8 （G8）筛查工具进行评估。通过接收者操作特征（ROC）曲线分析和使用约登指数确定截断值，评估 G8 预测生存率的能力。使用 Cox 比例风险回归分析验证 G8 与其他与预后相关的因素（年龄、表现状态（PS）、Charlson 合并症指数、口服药物数量（多药治疗）、生物营养状况的控制营养状况（CONUT）评分和治疗意向（根治性或姑息性））。在倾向评分加权队列中对生存分析进行验证，以纠正混杂因素。使用 Fisher 确切检验检查这些因素与并发症之间的相关性。
总生存率的 G8 截断值为 10.5（曲线下面积（AUC）为 0.69；95%置信区间（CI）为 0.56-0.82）。在倾向评分加权队列中，Cox 比例风险回归分析显示，异常 G8（<11）的风险比为 3.70 [1.59-8.61（p=0.002）]，PS 异常（≥2）的风险比为 0.85 [0.09-7.60（p=0.88）]。G8 异常组的 30 天死亡率和总并发症发生率显著更高。异常 G8 与重大并发症或转院均无相关性。
G8 是 HNC 老年患者强有力的预后因素和并发症的可能预测指标。
