在晚期肝胆胰恶性肿瘤患者中使用 Rockwood 临床虚弱量表。

Use of the Rockwood Clinical Frailty Scale in patients with advanced hepatopancreaticobiliary malignancies.

机构信息

Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK.

Department of Medical Oncology, The Christie NHS Foundation Trust/Division of Cancer Sciences, University of Manchester, Manchester, UK.

出版信息

Expert Rev Anticancer Ther. 2022 Sep;22(9):1009-1015. doi: 10.1080/14737140.2022.2096594. Epub 2022 Jul 6.

DOI:10.1080/14737140.2022.2096594

PMID:35768183

Abstract

BACKGROUND

Co-existing frailty in older patients with hepatopancreaticobiliary (HPB) malignancies is common. This study assessed the relationship between the Rockwood Clinical Frailty scale (CFS) and systemic anti-cancer therapy dose intensity (SACT-DI) and overall survival (OS) in patients with advanced HPB malignancies.

RESEARCH DESIGN AND METHODS

CFS was assessed prospectively for consecutive patients with newly diagnosed advanced HPB malignancy (The Christie; Sep-2019 to June-2020). Mann-Whitney U test assessed association between CFS, ECOG Performance Status (ECOG PS), and SACT-DI and Spearman's rank assessed the association between ECOG PS, age, and frailty. Survival analysis was performed using Kaplan-Meier and Cox regression.

RESULTS

Two hundred patients met inclusion criteria. SACT-DI was higher in Group-1 (not frail) (CFS 1-3)(median = 61%) than Group-2 (vulnerable/mildly frail) (CFS 4-5)(median = 25.1%), p < 0.001. Median OS was shorter in frail and pre-frail patients (HR 2.3(95%CI 1.8-2.9),p < 0.001. On multivariable analysis, both CFS (HR 1.5-(95%CI 1.2-1.9), p = 0.002) and ECOG PS (HR 1.9 (95%CI 1.6-2.3), p < 0.001) were independent prognostic factors for OS.

CONCLUSION

Frailty assessments, in addition to ECOG PS, may identify patients that will benefit from systemic therapy and are both independent prognostic factors for OS.

摘要

背景

老年肝胆胰恶性肿瘤患者常伴有衰弱。本研究评估了 Rockwood 临床虚弱量表（CFS）与晚期肝胆胰恶性肿瘤患者全身抗肿瘤治疗剂量强度（SACT-DI）和总生存（OS）之间的关系。

研究设计和方法

前瞻性评估了新诊断为晚期肝胆胰恶性肿瘤的连续患者（The Christie；2019 年 9 月至 2020 年 6 月）。Mann-Whitney U 检验评估了 CFS、ECOG 表现状态（ECOG PS）和 SACT-DI 之间的关系，Spearman 秩检验评估了 ECOG PS、年龄和虚弱之间的关系。使用 Kaplan-Meier 和 Cox 回归进行生存分析。

结果

符合纳入标准的患者有 200 例。在 CFS 1-3（中位 61%）的 Group-1（无虚弱）中，SACT-DI 高于 CFS 4-5（中位 25.1%）的 Group-2（脆弱/轻度虚弱），p < 0.001。虚弱和衰弱前期患者的中位 OS 更短（HR 2.3（95%CI 1.8-2.9），p < 0.001）。多变量分析显示，CFS（HR 1.5（95%CI 1.2-1.9），p = 0.002）和 ECOG PS（HR 1.9（95%CI 1.6-2.3），p < 0.001）均为 OS 的独立预后因素。