衰弱与老年癌症幸存者和无癌症病史成年人的死亡率风险：来自 1999-2014 年全国健康和营养调查的证据。
Frailty and risk of mortality in older cancer survivors and adults without a cancer history: Evidence from the National Health and Nutrition Examination Survey, 1999-2014.
机构信息
Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, Florida.
University of Florida Health Cancer Center, Gainesville, Florida.
出版信息
Cancer. 2022 Aug 1;128(15):2978-2987. doi: 10.1002/cncr.34258. Epub 2022 May 24.
BACKGROUND
Epidemiologic evidence reporting the role of frailty in survival among older adults with a prior cancer diagnosis is limited.
METHODS
A total of 2050 older adults (≥60 years old) surviving for at least 1 year after a cancer diagnosis and 9474 older adults without a cancer history from the National Health and Nutrition Examination Survey (1999-2014) were included for analysis. The exposure variable, a 45-item frailty index (FI), was categorized on the basis of validated cutoffs (FI ≤ 0.10 [fit], 0.10 < FI ≤ 0.21 [prefrail], and FI > 0.21 [frail]). All-cause mortality was ascertained via the National Death Index. Multivariable Cox proportional hazards models were used to estimate adjusted hazard ratios (aHRs) and 95% confidence interval (CIs) for the FI, and this was followed by restricted cubic splines depicting dose-response curves.
RESULTS
For older cancer survivors, the mean age at the baseline was 72.6 years (SD, 7.1 years); 5.9% were fit, 38.2% were prefrail, and 55.9% were frail. Older adults without a cancer history were slightly younger (mean age, 70.0 years) and less frail (47.9% were frail). At each level of the FI, cancer survivors (1.9 per 100 person-years for FI ≤ 0.10, 3.4 per 100 person-years for 0.10 < FI ≤ 0.21, and 7.5 per 100 person-years for FI > 0.21) had higher mortality than their cancer-free counterparts (1.4 per 100 person-years for FI ≤ 0.10, 2.4 per 100 person-years for 0.10 < FI ≤ 0.21, and 5.4 per 100 person-years for FI > 0.21). The multivariable model suggested a positive association between the FI and all-cause mortality for survivors (aHR for FI > 0.21 vs FI ≤ 0.10, 2.80; 95% CI, 1.73-4.53) and participants without a cancer history (aHR for FI > 0.21 vs FI ≤ 0.10, 2.75; 95% CI, 2.29-3.32). Restricted cubic splines indicated that all-cause mortality risk increased with the FI in a monotonic pattern.
CONCLUSIONS
Frailty is associated with a higher risk of death in older cancer survivors and the elderly without a cancer history.
背景
有关衰弱在有既往癌症诊断的老年患者生存中的作用的流行病学证据有限。
方法
从国家健康和营养检查调查（1999-2014 年）中纳入了 2050 名至少在癌症诊断后存活 1 年的老年人（≥60 岁）和 9474 名无癌症病史的老年人，用于分析。暴露变量是一个 45 项的衰弱指数（FI），根据验证的截止值进行分类（FI≤0.10[健康]，0.10<FI≤0.21[前期衰弱]，FI>0.21[衰弱]）。通过国家死亡指数确定全因死亡率。多变量 Cox 比例风险模型用于估计 FI 的调整后的风险比（aHR）和 95%置信区间（CI），并随后使用限制立方样条描绘剂量-反应曲线。
结果
对于老年癌症幸存者，基线时的平均年龄为 72.6 岁（SD，7.1 岁）；5.9%为健康，38.2%为前期衰弱，55.9%为衰弱。无癌症病史的老年人年龄略小（平均年龄为 70.0 岁），衰弱程度较低（47.9%为衰弱）。在 FI 的每个水平上，癌症幸存者（FI≤0.10 为每 100 人年 1.9 例，0.10<FI≤0.21 为每 100 人年 3.4 例，FI>0.21 为每 100 人年 7.5 例）的死亡率均高于无癌症病史的患者（FI≤0.10 为每 100 人年 1.4 例，0.10<FI≤0.21 为每 100 人年 2.4 例，FI>0.21 为每 100 人年 5.4 例）。多变量模型表明，FI 与幸存者（FI>0.21 与 FI≤0.10 的 aHR，2.80；95%CI，1.73-4.53）和无癌症病史的参与者（FI>0.21 与 FI≤0.10 的 aHR，2.75；95%CI，2.29-3.32）之间存在正相关。限制立方样条表明，全因死亡率风险呈单调递增模式随 FI 增加而增加。
结论
衰弱与老年癌症幸存者和无癌症病史的老年人的死亡风险增加有关。
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