Wind Philippe, Ap Thomas Zoe, Laurent Marie, Aparicio Thomas, Siebert Matthieu, Audureau Etienne, Paillaud Elena, Bousquet Guilhem, Pamoukdjian Frédéric
Service de Chirurgie Digestive et Cancérologique, Hôpital Avicenne, APHP, 93000 Bobigny, France.
Service d'oncologie Médicale, Hôpital Avicenne, APHP, 93000 Bobigny, France.
Cancers (Basel). 2021 Dec 27;14(1):117. doi: 10.3390/cancers14010117.
We aimed to assess the prognostic value of the pre-operative GRADE score for long-term survival among older adults undergoing major surgery for digestive or non-breast gynaecological cancers. Between 2013 and 2019, 136 consecutive older adults with cancer were prospectively recruited from the PF-EC cohort study before major cancer surgery and underwent a geriatric assessment. The GRADE score includes weight loss, gait speed at the threshold of 0.8 m/s, cancer site and cancer extension. The primary outcome was post-operative 5-year mortality. Patients were classified as low risk (GRADE ≤ 8) or high risk (GRADE > 8) on the basis of the median score. A Cox multivariate proportional hazards regression model was performed to assess the association between pre-operative factors and 5-year mortality expressed by adjusted hazard ratio (aHR) and 95% CI. The median age was 80 years, 52% were men, 73% had colorectal cancer. The 30-day post-operative severe complication rate (Clavien-Dindo ≥ 3) was 37%. The 5-year post-operative mortality rate was 34.5%. A GRADE score ≥ 8 (aHR = 2.64 [1.34-5.21], = 0.0002) was associated with post-operative mortality after adjustment for Body Mass Index < 21 kg/m and Instrumental Activities of Daily Living <3/4. By combining very simple geriatric and cancer parameters, the pre-operative GRADE score provides a discriminant prognosis and could help to choose the most suitable treatment strategy for older cancer patients, avoiding under or over-treatment.
我们旨在评估术前GRADE评分对接受消化或非乳腺妇科癌症大手术的老年人长期生存的预后价值。2013年至2019年期间，从PF-EC队列研究中前瞻性招募了136例连续的老年癌症患者，这些患者在进行重大癌症手术前接受了老年评估。GRADE评分包括体重减轻、步态速度阈值为0.8 m/s、癌症部位和癌症扩展情况。主要结局是术后5年死亡率。根据中位数评分将患者分为低风险（GRADE≤8）或高风险（GRADE>8）。采用Cox多变量比例风险回归模型，以调整后的风险比（aHR）和95%置信区间评估术前因素与5年死亡率之间的关联。中位年龄为80岁，52%为男性，73%患有结直肠癌。术后30天严重并发症发生率（Clavien-Dindo≥3）为37%。术后5年死亡率为34.5%。在调整体重指数<21 kg/m²和日常生活活动能力<3/4后，GRADE评分≥8（aHR = 2.64 [1.34 - 5.21]，P = 0.0002）与术后死亡率相关。通过结合非常简单的老年和癌症参数，术前GRADE评分提供了一种判别预后的方法，有助于为老年癌症患者选择最合适的治疗策略，避免治疗不足或过度治疗。
