老年患者癌症放疗后常出现老年病损，且与生存相关：一项前瞻性观察研究。
Geriatric impairments are prevalent and predictive of survival in older patients with cancer receiving radiotherapy: a prospective observational study.
机构信息
The Research Center for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway.
Department of Internal Medicine, Innlandet Hospital Trust, Hamar, Norway.
出版信息
Acta Oncol. 2022 Apr;61(4):393-402. doi: 10.1080/0284186X.2021.2009561. Epub 2021 Dec 7.
BACKGROUND
A systematic assessment of problems that are frequent in older age (geriatric assessment [GA]) provides prognostic information for patients undergoing cancer surgery and systemic cancer treatment. We aimed to investigate the prevalence of geriatric impairments and their impact on survival in older patients with cancer receiving radiotherapy (RT).
MATERIAL AND METHODS
A single-centre prospective observational study was conducted including patients ≥65 years referred for curative or palliative RT. Prior to RT, we performed a modified GA (mGA) assessing comorbidities, medications, nutritional status basic- and instrumental activities of daily living (IADL) mobility, falls, cognition and depressive symptoms. Impairments in each mGA domain were defined. Overall survival (OS) was presented by Kaplan Meier plots for groups defined according to the number of impairments, and compared by log-rank test. The association between mGA domains and OS was assessed by Cox proportional hazard regression analysis.
RESULTS
Between February 2017 and July 2018, 301 patients were included, 142 (47.2%) were women. Mean age was 73.6 (SD 6.3) years, 162 (53.8%) received curative RT. During the median observation time of 24.2 months (min 0.3, max 25.9), 123 (40.9%) patients died. In the overall cohort, 49 (16.3%) patients had no geriatric impairment, 81 (26.9%) had four or more. OS significantly decreased with an increasing number of impairments ( < .01). Nutritional status (HR 0.90, 95% CI [0.81; 0.99], = .038) and IADL function (HR 0.98, 95% CI [0.95; 1.00], = .027) were independent predictors of OS.
CONCLUSION
Geriatric impairments were frequent among older patients with cancer receiving RT and nutritional status and IADL function predicted OS. Targeted interventions to remediate modifiable impairments may have the potential to improve OS.
TRIAL REGISTRATION
Cinicaltrials.gov ID:NCT03071640.
背景
对老年人常见问题（老年综合评估[GA]）进行系统评估可为接受癌症手术和全身癌症治疗的患者提供预后信息。我们旨在研究在接受放疗（RT）的老年癌症患者中，老年综合评估中发现的功能障碍的发生率及其对生存的影响。
材料和方法
这是一项单中心前瞻性观察性研究，纳入了≥ 65 岁接受根治性或姑息性 RT 的患者。在 RT 之前，我们进行了改良的 GA（mGA）评估，包括合并症、药物使用情况、营养状况、基本和工具性日常生活活动（IADL）、移动能力、跌倒、认知和抑郁症状。定义了每个 mGA 领域的功能障碍。根据功能障碍的数量，通过 Kaplan-Meier 图呈现总生存（OS），并通过对数秩检验进行比较。通过 Cox 比例风险回归分析评估 mGA 域与 OS 的相关性。
结果
2017 年 2 月至 2018 年 7 月期间，共纳入 301 例患者，其中 142 例（47.2%）为女性。平均年龄为 73.6（SD 6.3）岁，162 例（53.8%）接受根治性 RT。在中位 24.2 个月（最小 0.3，最大 25.9）的观察期内，123 例（40.9%）患者死亡。在整个队列中，49 例（16.3%）患者没有老年综合评估中的功能障碍，81 例（26.9%）有 4 项或更多功能障碍。OS 随功能障碍数量的增加而显著降低（ < .01）。营养状况（HR 0.90，95%CI [0.81；0.99]， = .038）和 IADL 功能（HR 0.98，95%CI [0.95；1.00]， = .027）是 OS 的独立预测因素。
结论
在接受 RT 的老年癌症患者中，老年综合评估中的功能障碍很常见，营养状况和 IADL 功能可预测 OS。针对可纠正的功能障碍进行靶向干预可能有改善 OS 的潜力。
试验注册
Clinicaltrials.gov ID：NCT03071640。
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