Nishijima Tomohiro F, Deal Allison M, Williams Grant R, Sanoff Hanna K, Nyrop Kirsten A, Muss Hyman B
Geriatric Oncology Service, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan.
Department of Gastrointestinal and Medical Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan.
Cancer. 2022 May 15;128(10):1929-1936. doi: 10.1002/cncr.34135. Epub 2022 Feb 11.
Little is known regarding the predictive value of the Cancer and Aging Research Group (CARG) score, a validated chemotherapy toxicity prediction tool for older adults with cancer, for survival outcomes.
This was a prospective observational study of patients ≥65 years old receiving first-line chemotherapy for advanced noncolorectal gastrointestinal cancer for which combination chemotherapy is the standard of care. Overall survival (OS), time to treatment failure (TTF), which was defined as the time from the start of first-line chemotherapy to the discontinuation of first-line chemotherapy for any reason, and toxicity were compared in 4 groups of patients: 1) non-high-risk (nHR) CARG score (<10) and standard-intensity therapy (ST), 2) nHR score and reduced-intensity therapy (RT), 3) high-risk (HR) CARG score (≥10) and ST, and 4) HR score and RT.
Fifty patients (median age, 71 years) were enrolled. The median OS in months was 19.7 in nHR/ST (n = 19) group, 12.7 in nHR/RT (n = 9) group, 4.5 in HR/ST (n = 12) group, and 3.9 in HR/RT (n = 10) group (log-rank test, P = .005). The median TTF in months was 9.1 in nHR/ST group, 2.5 in nHR/RT group, 2.3 in HR/ST group, and 3.0 in HR/RT group (log-rank test, P = .04). The CARG-score category was prognostic of OS (HR, 3.04; 95% confidence interval [CI], 1.59-5.83, P = .001) and TTF (HR, 2.60; 95% CI, 1.31-5.20, P = .007). The incidence of grade 3-5 toxicity was 68% in nHR/ST group, 33% in nHR/RT group, 92% in HR/ST group, and 70% in HR/RT group (Fisher exact test, P = .048).
Risk-adapted chemotherapy based on the CARG-score may improve treatment outcomes.
癌症与衰老研究组（CARG）评分作为一种已验证的针对老年癌症患者的化疗毒性预测工具，其对生存结果的预测价值鲜为人知。
这是一项前瞻性观察性研究，研究对象为年龄≥65岁、接受晚期非结直肠癌胃肠道癌一线化疗（联合化疗为标准治疗方案）的患者。比较了4组患者的总生存期（OS）、治疗失败时间（TTF，定义为从一线化疗开始至因任何原因停止一线化疗的时间）和毒性：1）非高危（nHR）CARG评分（<10）且接受标准强度治疗（ST）的患者，2）nHR评分且接受降低强度治疗（RT）的患者，3）高危（HR）CARG评分（≥10）且接受ST的患者，4）HR评分且接受RT的患者。
共纳入50例患者（中位年龄71岁）。nHR/ST组（n = 19）的中位OS为19.7个月，nHR/RT组（n = 9）为12.7个月，HR/ST组（n = 12）为4.5个月，HR/RT组（n = 10）为3.9个月（对数秩检验，P = 0.005）。nHR/ST组的中位TTF为9.1个月，nHR/RT组为2.5个月，HR/ST组为2.3个月，HR/RT组为3.0个月（对数秩检验，P = 0.04）。CARG评分类别对OS（风险比[HR]，3.04；95%置信区间[CI]，1.59 - 5.83，P = 0.001）和TTF（HR，2.60；95% CI，1.31 - 5.20，P = 0.007）具有预后意义。3 - 5级毒性的发生率在nHR/ST组为68%，nHR/RT组为33%，HR/ST组为92%，HR/RT组为70%（Fisher精确检验，P = 0.048）。
基于CARG评分的风险适应性化疗可能改善治疗结果。
