基于代谢组学的预测评分对老年实体瘤患者死亡率的预测性能。
The performance of metabolomics-based prediction scores for mortality in older patients with solid tumors.
机构信息
Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, PO box 9600, 2300 RC, Leiden, The Netherlands.
LUMC Center for Medicine for Older People, Leiden University Medical Center, Leiden, The Netherlands.
出版信息
Geroscience. 2024 Dec;46(6):5615-5627. doi: 10.1007/s11357-024-01261-6. Epub 2024 Jul 4.
Prognostic information is needed to balance benefits and risks of cancer treatment in older patients. Metabolomics-based scores were previously developed to predict 5- and 10-year mortality (MetaboHealth) and biological age (MetaboAge). This study aims to investigate the association of MetaboHealth and MetaboAge with 1-year mortality in older patients with solid tumors, and to study their predictive value for mortality in addition to established clinical predictors. This prospective cohort study included patients aged ≥ 70 years with a solid malignant tumor, who underwent blood sampling and a geriatric assessment before treatment initiation. The outcome was all-cause 1-year mortality. Of the 192 patients, the median age was 77 years. With each SD increase of MetaboHealth, patients had a 2.32 times increased risk of mortality (HR 2.32, 95% CI 1.59-3.39). With each year increase in MetaboAge, there was a 4% increased risk of mortality (HR 1.04, 1.01-1.07). MetaboHealth and MetaboAge showed an AUC of 0.66 (0.56-0.75) and 0.60 (0.51-0.68) for mortality prediction accuracy, respectively. The AUC of a predictive model containing age, primary tumor site, distant metastasis, comorbidity, and malnutrition was 0.76 (0.68-0.83). Addition of MetaboHealth increased AUC to 0.80 (0.74-0.87) (p = 0.09) and AUC did not change with MetaboAge (0.76 (0.69-0.83) (p = 0.89)). Higher MetaboHealth and MetaboAge scores were associated with 1-year mortality. The addition of MetaboHealth to established clinical predictors only marginally improved mortality prediction in this cohort with various types of tumors. MetaboHealth may potentially improve identification of older patients vulnerable for adverse events, but numbers were too small for definitive conclusions. The TENT study is retrospectively registered at the Netherlands Trial Register (NTR), trial number NL8107. Date of registration: 22-10-2019.
预后信息对于平衡老年癌症患者的治疗获益和风险至关重要。基于代谢组学的评分系统此前已被开发出来,用于预测 5 年和 10 年死亡率(MetaboHealth)和生物年龄(MetaboAge)。本研究旨在探讨 MetaboHealth 和 MetaboAge 与老年实体瘤患者 1 年死亡率的相关性,并研究它们对死亡率的预测价值,以及对既定临床预测因素的补充。这是一项前瞻性队列研究,纳入了年龄≥70 岁、患有实体恶性肿瘤的患者,这些患者在治疗开始前进行了血液采样和老年评估。主要结局为全因 1 年死亡率。在 192 名患者中,中位年龄为 77 岁。MetaboHealth 每增加 1 个标准差,患者死亡风险增加 2.32 倍(HR 2.32,95%CI 1.59-3.39)。MetaboAge 每增加 1 岁,死亡风险增加 4%(HR 1.04,1.01-1.07)。MetaboHealth 和 MetaboAge 对死亡率的预测准确性的 AUC 分别为 0.66(0.56-0.75)和 0.60(0.51-0.68)。包含年龄、原发肿瘤部位、远处转移、合并症和营养不良的预测模型的 AUC 为 0.76(0.68-0.83)。加入 MetaboHealth 后 AUC 增加到 0.80(0.74-0.87)(p=0.09),而加入 MetaboAge 后 AUC 没有变化(0.76(0.69-0.83)(p=0.89))。较高的 MetaboHealth 和 MetaboAge 评分与 1 年死亡率相关。在包含各种类型肿瘤的队列中,将 MetaboHealth 加入既定的临床预测因素仅略微改善了死亡率的预测。MetaboHealth 可能有助于识别易发生不良事件的老年患者,但数量太少,无法得出明确结论。TENT 研究在荷兰临床试验注册库(NTR)进行了回顾性注册,注册号为 NL8107。注册日期:2019 年 10 月 22 日。
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