Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
Institute for Cancer Outcomes & Survivorship, University of Alabama at Birmingham, Birmingham, AL.
JCO Oncol Pract. 2022 Nov;18(11):e1796-e1806. doi: 10.1200/OP.22.00270. Epub 2022 Sep 8.
PURPOSE: Frailty predicts poor outcomes in older adults with cancer, but how it differs between different cancer types is unknown. We examined differences in pretreatment frailty between colorectal (CRC), pancreatic, and hepatobiliary cancers. METHODS: We included older adults age 60 years or older with the above cancer types enrolled in the Cancer and Aging Resilience Evaluation registry. Frailty was defined using a 44-item Cancer and Aging Resilience Evaluation frailty index constructed on the basis of the principles of deficit accumulation (including several geriatric assessment impairments encompassing malnutrition, functional status, comorbidities, anxiety, depression, cognitive complaints, health-related quality of life, falls, ability to walk one block, interference in social activities, and polypharmacy). Multivariable logistic regression models were used to examine the adjusted odds ratio (aOR) of frailty between cancer types. RESULTS: A total of 505 patients were included (mean age 70 years, 59% male): 211 (41.8%) CRC, 178 (35.2%)pancreatic cancer, and 116 (23.0%) hepatobiliary cancer. Patients with pancreatic cancer had the highest prevalence of frailty (23.3% CRC, 40.6% pancreatic, 34.3% hepatobiliary; = .001). Both pancreatic (aOR, 2.18; 95% CI, 1.38 to 3.45), and hepatobiliary cancer (aOR, 1.73; 95% CI, 1.03 to 2.93) were independently associated with higher odds of frailty relative to CRC. Frailty was driven by higher rates of malnutrition and instrumental activities of daily living impairments in patients with pancreatic cancer and higher number of comorbidities in patients with hepatobiliary cancer. CONCLUSION: Older adults with pancreatic and hepatobiliary cancers are at high-risk of pretreatment frailty. Early interventions to improve nutritional and functional status and optimization of comorbidities may help improve outcomes.
目的:虚弱预测老年癌症患者预后不良,但不同癌症类型之间的差异尚不清楚。我们研究了大肠癌(CRC)、胰腺癌和肝胆癌患者之间治疗前虚弱的差异。
方法:我们纳入了年龄在 60 岁或以上的上述癌症类型的癌症和衰老弹性评估登记处的老年患者。使用基于缺陷积累原则构建的包含多种老年评估障碍(包括营养不良、功能状态、合并症、焦虑、抑郁、认知抱怨、健康相关生活质量、跌倒、步行一个街区的能力、社会活动干扰和多药治疗)的 44 项癌症和衰老弹性评估虚弱指数来定义虚弱。多变量逻辑回归模型用于检查癌症类型之间虚弱的调整比值比(aOR)。
结果:共纳入 505 例患者(平均年龄 70 岁,59%为男性):211 例(41.8%)CRC、178 例(35.2%)胰腺癌和 116 例(23.0%)肝胆癌。胰腺癌患者虚弱的患病率最高(CRC23.3%,胰腺癌 40.6%,肝胆癌 34.3%; =.001)。与 CRC 相比,胰腺癌(aOR,2.18;95%CI,1.38 至 3.45)和肝胆癌(aOR,1.73;95%CI,1.03 至 2.93)独立与更高的虚弱几率相关。胰腺癌患者的营养不良和日常生活活动障碍发生率较高,肝胆癌患者的合并症较多,导致虚弱。
结论:患有胰腺癌和肝胆癌的老年患者在治疗前虚弱的风险较高。早期干预改善营养和功能状态以及合并症的优化可能有助于改善预后。
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