Fletcher James A, Fox Sarah T, Reid Natasha, Hubbard Ruth E, Ladwa Rahul
Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland 4102, Australia; Faculty of Medicine, The University of Queensland. 199 Ipswich Road, Woolloongabba, Queensland 4102, Australia; Centre for Health Services Research, Faculty of Medicine, The University of Queensland, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia.
Centre for Health Services Research, Faculty of Medicine, The University of Queensland, 199 Ipswich Road, Woolloongabba, QLD 4102, Australia; The Prince Charles Hospital, 627 Rode Rd, Chermside, Queensland, QLD 4032, Australia.
Cancer Treat Res Commun. 2022;33:100652. doi: 10.1016/j.ctarc.2022.100652. Epub 2022 Oct 18.
Frailty is prevalent in older adults with lung cancer, however the impact of frailty in this population is not well understood. The aim of this review was to evaluate the outcomes that are measured in frail older adults with lung cancer, and to determine the associations between frailty and these outcomes.
A systematic online search of PubMed, EMBASE, and Cochrane databases was conducted to identify all English-language studies between January 2015 and May 2022 prospectively evaluating frailty and outcomes in older adults (median age > 65 years) with lung cancer. Studies were excluded if frailty was defined by a single domain assessment or not clearly defined. Quality was assessed using the Newcastle-Ottawa Scale.
Of 1891 studies screened, 16 met inclusion criteria. The median number of patients was 96 (range 26-494) and the mean age was 76.6 years. Eight different frailty assessments were used, and frailty definitions varied widely. The most frequently assessed outcomes were overall survival (n = 13,81%), treatment-related toxicity (n = 8,50%), hospitalisation (n = 5,31%), and treatment completion/discontinuation (n = 4,25%). Quality of life (n = 3,19%), function (n = 1,6%), frailty trajectory (n = 1,6%), and emergency visits (n = 1,6%) were infrequently assessed. Frailty had a strong and consistent association with mortality (Hazard Ratio range: 3.5-11.91). It was also associated with treatment-related toxicity and treatment selection. The remaining outcomes were not statistically significant.
These data support frailty as an important predictor of mortality in older adults with lung cancer, however further research is warranted to determine the association between frailty and other meaningful endpoints for this vulnerable population.
衰弱在老年肺癌患者中普遍存在，然而衰弱对这一人群的影响尚未得到充分理解。本综述的目的是评估在衰弱的老年肺癌患者中所测量的结局，并确定衰弱与这些结局之间的关联。
对PubMed、EMBASE和Cochrane数据库进行系统的在线检索，以识别2015年1月至2022年5月期间所有前瞻性评估老年（中位年龄>65岁）肺癌患者衰弱及结局的英文研究。如果衰弱是通过单一领域评估定义的或定义不明确，则排除该研究。使用纽卡斯尔-渥太华量表评估质量。
在筛选的1891项研究中，16项符合纳入标准。患者的中位数为96例（范围26 - 494例），平均年龄为76.6岁。使用了8种不同的衰弱评估方法，衰弱的定义差异很大。最常评估的结局是总生存期（n = 13，81%）、治疗相关毒性（n = 8，50%）、住院（n = 5，31%）以及治疗完成/中断（n = 4，25%）。生活质量（n = 3，19%）、功能（n = 1，6%）、衰弱轨迹（n = 1，6%）和急诊就诊（n = 1，6%）很少被评估。衰弱与死亡率有强烈且一致的关联（风险比范围：3.5 - 11.91）。它还与治疗相关毒性和治疗选择有关。其余结局无统计学意义。
这些数据支持衰弱是老年肺癌患者死亡率的重要预测因素，然而有必要进一步研究以确定衰弱与这一脆弱人群其他有意义终点之间的关联。
