Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, the Netherlands.
Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, the Netherlands.
J Geriatr Oncol. 2024 Nov;15(8):102075. doi: 10.1016/j.jgo.2024.102075. Epub 2024 Oct 16.
To balance benefits and risks of cancer treatment in older patients, prognostic information is needed. The Glasgow Prognostic Score (GPS), composed of albumin and C-reactive protein (CRP), might provide such information. This study first aims to investigate the association between GPS and frailty, functional decline, and health-related quality of life (HRQoL) decline as indicators of health problems in older patients with cancer. The second aim is to study the predictive value of GPS for mortality, in addition to clinical predictors.
This prospective cohort study included patients aged ≥70 years with a solid malignant tumor who underwent a geriatric assessment and blood sampling before treatment initiation. GPS was calculated using serum albumin and CRP measured in batch, categorized into normal (0) and abnormal GPS (1-2). Outcomes were all-cause mortality and a composite outcome of decline in daily functioning and/or HRQoL, or mortality at one year follow-up. Daily functioning was assessed by Activities of Daily Living and Instrumental Activities of Daily Living questionnaires and HRQoL by the EQ-5D-3L and EQ-VAS questionnaires.
In total, 192 patients with a median age of 77 years (interquartile range 72.3-81.0) were included. Patients with abnormal GPS were more often frail compared to those with normal GPS (79 % vs. 63 %, p = 0.03). Patients with abnormal GPS had higher mortality rates after one year compared to those with normal GPS (48 % vs. 23 %, p < 0.01) in unadjusted analysis. Abnormal GPS was associated with increased mortality risk (hazard ratio 2.8, 95 % CI 1.7-4.8). The area under the receiver operating characteristics curve of age, distant metastasis, tumor site, comorbidity, and malnutrition combined was 0.73 (0.68-0.83) for mortality prediction, and changed to 0.78 (0.73-0.86) with GPS (p = 0.10). The composite outcome occurred in 88 % of patients with abnormal GPS versus 83 % with normal GPS (p = 0.44).
Abnormal GPS was associated with frailty and mortality. The addition of GPS to clinical predictors showed a numerically superior mortality prediction in this cohort of older patients with cancer, although not statistically significant. While GPS may improve the stratification of future older patients with cancer, larger studies including older patients with similar tumor types are necessary to evaluate its clinical usefulness.
The TENT study is retrospectively registered at the Netherlands Trial Register (NTR), trial number NL8107. Date of registration: 22-10-2019.
为了平衡老年癌症患者治疗的获益和风险，需要预后信息。由白蛋白和 C 反应蛋白（CRP）组成的格拉斯哥预后评分（GPS）可能提供此类信息。本研究首先旨在探讨 GPS 与虚弱、功能下降和健康相关生活质量（HRQoL）下降之间的关系，这些都是老年癌症患者健康问题的指标。其次，研究 GPS 对死亡率的预测价值，除了临床预测因素外。
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接受了老年评估和血液采样。GPS 是使用批量测量的血清白蛋白和 CRP 计算的，分为正常（0）和异常 GPS（1-2）。结局是全因死亡率和日常功能下降和/或 HRQoL 或一年随访时死亡率的复合结局。日常功能通过日常生活活动和工具性日常生活活动问卷评估，HRQoL 通过 EQ-5D-3L 和 EQ-VAS 问卷评估。
共纳入 192 名中位年龄为 77 岁（四分位距 72.3-81.0）的患者。与正常 GPS 患者相比，异常 GPS 患者更易出现虚弱（79% vs. 63%，p=0.03）。在未调整分析中，异常 GPS 患者的一年死亡率高于正常 GPS 患者（48% vs. 23%，p<0.01）。异常 GPS 与死亡率增加相关（风险比 2.8，95%CI 1.7-4.8）。年龄、远处转移、肿瘤部位、合并症和营养不良联合预测死亡率的受试者工作特征曲线下面积为 0.73（0.68-0.83），加入 GPS 后为 0.78（0.73-0.86）（p=0.10）。异常 GPS 组有 88%的患者发生复合结局，而正常 GPS 组有 83%（p=0.44）。
异常 GPS 与虚弱和死亡率相关。在该队列的老年癌症患者中，将 GPS 与临床预测因素相结合可提高死亡率预测的数值，但无统计学意义。虽然 GPS 可能改善未来老年癌症患者的分层，但需要更大规模的研究纳入具有相似肿瘤类型的老年患者，以评估其临床实用性。
TENT 研究在荷兰试验注册处（NTR）进行了回顾性注册，注册号 NL8107。注册日期：2019 年 10 月 22 日。
