Division of Hematology & Oncology, Department of Medicine, University of Alabama at Birmingham, AL, USA.
Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, Birmingham, AL, USA.
J Geriatr Oncol. 2024 Nov;15(8):102051. doi: 10.1016/j.jgo.2024.102051. Epub 2024 Sep 5.
Several frailty assessment tools exist for classifying older adults with multiple myeloma (MM) by their frailty status, such as the International Myeloma Working Group (IMWG) frailty score and the simplified frailty scale. The level of agreement between the IMWG frailty score and the simplified frailty scale remains unknown.
In a cross-sectional analysis of a prospective cohort study, we identified adults ≥50y initiating a new treatment regimen for MM who underwent a baseline geriatric assessment (GA). Using data from the GA and electronic health records, we measured IMWG frailty score and the simplified frailty scale, and classified patients by frailty status. We merged the fit and intermediate-fit categories of IMWG frailty score to create a binary category (frail, non-frail) for comparison with simplified frailty scale and measured their agreement using Cohen's Kappa statistic. We tested the diagnostic utility of simplified frailty scale as a screening tool using IMWG frailty score as the gold standard, using sensitivity, specificity, and decision curve analysis (DCA).
Three hundred older adults were included with a median age at diagnosis of 64y; 56 % were male and 63 % were non-Hispanic White. By IMWG frailty score, 41 % were fit, 38 % intermediate-fit, and 21 % frail, while simplified frailty scale indicated 22 % frail and 78 % non-frail patients. The agreement between IMWG frailty score and simplified frailty scale was moderate (κ = 0.43); 19 % of the patients were misclassified. Despite discordance, when testing simplified frailty scale as a screening tool, we found a sensitivity of 56 % and specificity of 87 % to diagnose frailty. Substituting patient-reported performance status (PS) instead of physician reported ECOG PS led to a sensitivity of 91 % and specificity of 61 %. DCA showed that using simplified frailty scale (with patient reported PS) as a screening tool led to a 43-44 % reduction in the number of unnecessary GAs across reasonable threshold probabilities.
IMWG frailty score and simplified frailty scale have limited agreement with each other. This creates a possibility of misclassification bias and poses difficulty in comparing existing literature on frail patients with MM. Despite discordance, simplified frailty scale may have a potential role as a screening tool, when using patient-reported PS.
目前有多种虚弱评估工具可用于根据虚弱状况对多发性骨髓瘤（MM）老年患者进行分类，例如国际骨髓瘤工作组（IMWG）虚弱评分和简化虚弱量表。但是，IMWG 虚弱评分与简化虚弱量表之间的一致性程度尚不清楚。
在一项前瞻性队列研究的横断面分析中，我们确定了接受新 MM 治疗方案的年龄≥50 岁的成年人，并进行了基线老年评估（GA）。使用 GA 和电子健康记录中的数据，我们测量了 IMWG 虚弱评分和简化虚弱量表，并根据虚弱状况对患者进行分类。我们将 IMWG 虚弱评分的 fit 和 intermediate-fit 类别合并为一个二进制类别（虚弱、非虚弱），与简化虚弱量表进行比较，并使用 Cohen 的 Kappa 统计量测量它们之间的一致性。我们使用 IMWG 虚弱评分作为金标准，通过敏感性、特异性和决策曲线分析（DCA）来测试简化虚弱量表作为筛查工具的诊断效用。
共纳入 300 名老年患者，中位诊断年龄为 64 岁；56%为男性，63%为非西班牙裔白人。根据 IMWG 虚弱评分，41%为 fit，38%为 intermediate-fit，21%为虚弱；而简化虚弱量表则显示 22%为虚弱，78%为非虚弱患者。IMWG 虚弱评分与简化虚弱量表之间的一致性为中等（κ=0.43）；有 19%的患者被错误分类。尽管存在差异，但当我们使用简化虚弱量表作为筛查工具进行测试时，我们发现其诊断虚弱的敏感性为 56%，特异性为 87%。用患者报告的表现状态（PS）代替医生报告的 ECOG PS 后，敏感性为 91%，特异性为 61%。DCA 显示，使用简化虚弱量表（结合患者报告的 PS）作为筛查工具可将合理阈值概率范围内不必要的 GA 数量减少 43-44%。
IMWG 虚弱评分和简化虚弱量表之间的一致性有限。这可能导致分类偏倚，并在比较 MM 虚弱患者的现有文献时造成困难。尽管存在差异，但简化虚弱量表在使用患者报告的 PS 时可能具有作为筛查工具的潜在作用。
