Department of Medical Oncology, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
Clinical Research Secretariat, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
J Geriatr Oncol. 2022 Jun;13(5):720-730. doi: 10.1016/j.jgo.2022.02.013. Epub 2022 Mar 10.
BACKGROUND: Geriatric 8 (G8) and Vulnerable Elders Survey-13 (VES-13) are quick and easy-to-use screening tools, developed and validated in older patients living in North America and Europe for predicting abnormalities in the subsequent geriatric assessment. The applicability of these screening tools in older Indian patients with cancer is not known. METHODS: An observational study in 308 Indian patients with cancer aged ≥60 years, who were evaluated in the Geriatric Oncology clinic at the Tata Memorial Hospital, Mumbai, India, between June 2018 and November 2020. Patients underwent the G8 and VES-13 screening tools followed by a geriatric assessment. The objectives were to determine the diagnostic accuracy of the G8/VES-13 screening tools to detect an abnormal geriatric assessment, to determine their association with the Eastern Cooperative Oncology Group (ECOG) performance status (PS)/Cancer Aging and Research Group (CARG) scores, to determine the optimal cut-off value on the G8 scale for older Indian patients with cancer, and to determine whether an abnormal G8/VES-13 score was associated with shorter survival. We also aimed to assess the utility of combining the G8 and VES-13 scores to predict for an abnormal geriatric assessment and poorer survival. RESULTS: The sensitivity and specificity of the G8 (cut-off, ≤14) score were 84.4% and 17.6%, respectively, whereas those for the VES-13 score (≥3) were 34.9% and 82.4%, respectively. The appropriate abnormal G8 cut-off score was noted to be 12. Abnormal G8 (≤14) and VES-13 scores were not associated with an abnormal subsequent geriatric assessment [p = 0.736 (G8)], while abnormal G8 (≤14) scores did not predict for worse survival outcomes. Lowering the cut-off of the G8 score to <12 and/or combining an abnormal G8 (<12) with the VES-13 score were found to be associated with an abnormal subsequent geriatric assessment [p < 0.001 (G8), p < 0.001(G8 + VES-13)] and predicted for worse survival. CONCLUSIONS: An abnormal G8 cut-off score < 12 is therefore appropriate in older Indian patients with cancer. G8 < 12 predicts for the presence of non-oncological vulnerabilities and shorter survival. Lowering the cutoff of G8 to 12translated to a 35% reduction in the number of patients undergoing a complete geriatric assessment. Combined with VES-13, the G8 can be reliably used to identify those patients who would benefit the most from a geriatric assessment and help in optimal resource utilization especially in busy Indian centers.
背景：老年 8 项（G8）和脆弱老年人调查 13 项（VES-13）是两种快速、易用的筛查工具，在北美和欧洲的老年患者中开发和验证，用于预测后续老年评估中的异常情况。这些筛查工具在印度老年癌症患者中的适用性尚不清楚。
方法：对 2018 年 6 月至 2020 年 11 月在印度孟买塔塔纪念医院老年肿瘤诊所接受评估的 308 名年龄≥60 岁的印度癌症患者进行了一项观察性研究。患者接受了 G8 和 VES-13 筛查工具的检测，随后进行了老年评估。目的是确定 G8/VES-13 筛查工具检测异常老年评估的诊断准确性，确定其与东部合作肿瘤学组（ECOG）表现状态（PS）/癌症老龄化和研究组（CARG）评分的相关性，确定 G8 量表在印度老年癌症患者中的最佳截断值，并确定异常 G8/VES-13 评分是否与较短的生存期相关。我们还旨在评估将 G8 和 VES-13 评分相结合以预测异常老年评估和较差生存的效用。
结果：G8（截断值，≤14）评分的敏感性和特异性分别为 84.4%和 17.6%，而 VES-13 评分（≥3）的敏感性和特异性分别为 34.9%和 82.4%。异常 G8 截断值为 12。异常 G8（≤14）和 VES-13 评分与后续异常老年评估无相关性[G8（p = 0.736）]，而异常 G8（≤14）评分与较差的生存结果无关。将 G8 评分的截断值降低到<12 并/或结合异常 G8（<12）和 VES-13 评分与后续异常老年评估相关[G8（p<0.001），G8+VES-13（p<0.001）]，并预测生存较差。
结论：因此，异常 G8 截断值<12 适用于印度老年癌症患者。G8<12 预测非肿瘤脆弱性和较短的生存期。将 G8 的截断值降低到 12 将使接受完整老年评估的患者数量减少 35%。与 VES-13 相结合，G8 可用于可靠地识别那些最受益于老年评估的患者，并有助于最佳资源利用，尤其是在繁忙的印度中心。
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