Department of Medical Oncology, Kagoshima City Hospital, 37-1 Uearata-cho, Kagoshima city, Kagoshima 890-8760, Japan.
Department of Medical Oncology, Kagoshima City Hospital, 37-1 Uearata-cho, Kagoshima city, Kagoshima 890-8760, Japan; Digestive and Lifestyle Diseases, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima city, Kagoshima 890-8520, Japan.
J Geriatr Oncol. 2021 Nov;12(8):1200-1207. doi: 10.1016/j.jgo.2021.05.006. Epub 2021 May 11.
Few studies have investigated factors influencing the efficacy of chemotherapy in older patients with cancer. This study aimed to evaluate the usefulness of G8, geriatric assessment (GA), and factors measured in general clinical practice for evaluating progression-free survival (PFS) of first-line palliative chemotherapy in older patients with advanced gastrointestinal cancer.
This was a prospective observational study of older patients (age ≥70 years) with advanced gastrointestinal cancer. The modified cut-off value of G8 was determined by referring to two or more abnormal GA conditions. The usefulness of baseline GA and G8 (conventional and modified cut-off value) was assessed according to the efficacy (PFS and disease control rate) of the administered first-line palliative chemotherapy.
Overall, 93 patients were evaluated between March 2017 and February 2019. A modified G8 cut-off value of ≤12 had a sensitivity and specificity of 68.9% and 46.9%, respectively. PFS was significantly prolonged in the patients with G8 > 12, serum albumin ≥3.5 g/dl, and in whom grade ≥3 adverse events occurred. There was no significant difference in the PFS between monotherapy and combination therapy. GA was not useful for predicting PFS prolongation or the occurrence of serious adverse events in first-line treatment.
Among older patients with advanced gastrointestinal cancer who receive first-line chemotherapy, a modified G8 cut-off value of 12 points, occurrence of grade 3 or higher adverse events, albumin levels, rather than age or performance status were predictors of PFS prolongation.
鲜有研究调查影响癌症老年患者化疗疗效的因素。本研究旨在评估 G8、老年综合评估（GA）和一般临床实践中测量的因素在评估晚期胃肠癌老年患者一线姑息化疗无进展生存期（PFS）中的作用。
这是一项针对年龄≥70 岁的晚期胃肠癌老年患者的前瞻性观察性研究。通过参考两项或更多异常 GA 情况来确定 G8 的改良截断值。根据一线姑息化疗的疗效（PFS 和疾病控制率）评估基线 GA 和 G8（常规和改良截断值）的作用。
2017 年 3 月至 2019 年 2 月期间，共评估了 93 例患者。G8≤12 的改良截断值的敏感性和特异性分别为 68.9%和 46.9%。G8＞12、血清白蛋白≥3.5g/dl 和发生≥3 级不良事件的患者 PFS 显著延长。单药治疗和联合治疗的 PFS 无显著差异。GA 对预测一线治疗中 PFS 延长或严重不良事件的发生并无作用。
在接受一线化疗的晚期胃肠癌老年患者中，G8 截断值为 12 分、发生 3 级或更高级别的不良事件、白蛋白水平，而非年龄或体能状态，是 PFS 延长的预测因素。
