De Schrevel Julia, Faucon Clémentine, Sibille François-Xavier, Dumont Laura, Herrmann Francois R, Rouvière Héloïse, De Breucker Sandra
Geriatric Department, Hôpital Universitaire de Bruxelles, Brussels, Belgium.
Geriatric Department, CHU UCL, Namur, Belgium.
Front Med (Lausanne). 2024 Sep 30;11:1466366. doi: 10.3389/fmed.2024.1466366. eCollection 2024.
The comprehensive geriatric assessment (CGA) is recommended for assessing frailty in older cancer patients but is time-consuming. The G8 screening tool was developed to select frail patients requiring CGA to optimize resources. The Edmonton Frail Scale (EFS) is another frailty scale validated for preoperative frailty screening, but scarcely studied in the field of oncogeriatrics. In this study, we examined the added value of the EFS in older cancer patients already considered as frail by the G8, by analyzing the association of EFS with CGA adjusted for age, gender, metastatic stage and comorbidity. We also analyzed the association of EFS with the one-year mortality rate after adjusting for cancer type and metastatic stage.
This retrospective study included patients aged over 70 years old with a new diagnosis of cancer, considered as potentially frail according to the G8 and who had had a CGA ( = 380).
The EFS identified 329 (86.58%) patients as frail and having a statistically significant predicted number of pathological components on the CGA ( = 0.64, < 0.001). When adjusted for age, sex, comorbidity, and metastatic stage, the EFS was independently associated with the CGA ( < 0001), as well as with comorbidity ( = 0.004). The patients who died in the first year (43%) had a significantly higher mean EFS score (8/17) than living patients (6/17) ( < 0.0001). After adjustment for cancer type and stage, EFS independently predicted one-year mortality (OR 1.17; 95% CI 1.08-1.28; pseudo = 0.228, < 0.001).
The EFS is a reliable tool for predicting frailty identified by the CGA in an older cancer population pre-selected as frail by the G8. EFS is an independent predictor of one-year mortality after adjustment for confounding factors. Validation of the EFS as a screening tool for frailty in cancer requires further studies to assess its performance in patients with normal G8 scores.
推荐采用综合老年评估（CGA）来评估老年癌症患者的虚弱状况，但该方法耗时较长。G8筛查工具旨在筛选出需要进行CGA以优化资源配置的虚弱患者。埃德蒙顿虚弱量表（EFS）是另一种经验证可用于术前虚弱筛查的量表，但在老年肿瘤学领域研究较少。在本研究中，我们通过分析EFS与经年龄、性别、转移分期和合并症校正后的CGA之间的关联，研究了EFS在已被G8判定为虚弱的老年癌症患者中的附加价值。我们还分析了在调整癌症类型和转移分期后EFS与一年死亡率之间的关联。
这项回顾性研究纳入了年龄超过70岁、新诊断为癌症、根据G8被认为可能虚弱且接受过CGA的患者（n = 380）。
EFS识别出329名（86.58%）患者为虚弱，且在CGA上具有统计学显著的预测病理成分数量（β = 0.64，P < 0.001）。在调整年龄、性别、合并症和转移分期后，EFS与CGA独立相关（P < 0.001），也与合并症相关（P = 0.004）。在第一年死亡的患者（43%）的平均EFS评分（8/17）显著高于存活患者（6/17）（P < 0.0001）。在调整癌症类型和分期后，EFS独立预测一年死亡率（OR 1.17；95% CI 1.08 - 1.28；伪R² = 0.228，P < 0.001）。
EFS是一种可靠的工具，可用于预测在被G8预先选定为虚弱的老年癌症人群中由CGA识别出的虚弱状况。EFS是在调整混杂因素后一年死亡率的独立预测因子。将EFS验证为癌症虚弱筛查工具需要进一步研究，以评估其在G8评分正常的患者中的表现。
