老年弥漫性大B细胞淋巴瘤患者的简化综合老年评估表现
The performance of abbreviated comprehensive geriatric assessment in elderly patients with diffuse large B cell lymphoma.
作者信息
Hung Yu-Shin, Chang Hung, Kuo Ming-Chung, Chou Wen-Chi
机构信息
Department of Hematology and Oncology, Geriatric Medical Center, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan.
出版信息
Support Care Cancer. 2025 Jan 8;33(2):81. doi: 10.1007/s00520-024-09142-6.
PURPOSE
Diffuse large B-cell lymphoma (DLBCL) is one of the most common and aggressive forms of non-Hodgkin's lymphoma. This study aimed to evaluate the performance of the abbreviated Comprehensive Geriatric Assessment (aCGA) in assessing frailty and predicting clinical outcomes in elderly patients with DLBCL.
METHODS
A total of 91 patients aged ≥ 65 years with newly diagnosed DLBCL and who received immunochemotherapy at a single medical center in Taiwan between August 2019 and December 2022 were prospectively enrolled. Frailty was assessed in all participating patients within seven days of the first cycle of immunochemotherapy. The primary objective was to compare aCGA's accuracy in assessing frailty with that of the full CGA. Secondary objectives included assessing correlations between frailty and severe adverse events (sAEs), early mortality, and overall survival (OS).
RESULTS
In the cohort, 50 (55%) and 38 (42%) patients were categorized as frail based on CGA and aCGA, respectively. A high number of aCGA domains impairment were positively associated with a high number of CGA domains impairment. The receiver operating characteristic for aCGA for detecting frailty was 0.846 (95% confidence interval [CI], 0.756-0.926). A cut-off point of ≥ 2 aCGA domain impairments indicated frailty, with a sensitivity of 70.0% and specificity of 92.7%. Based on aCGA, the early mortality rate was 7.5% and 26.3% (p = 0.019) for fit and frail patients, respectively. The 1-year and 2-year OS rates were 77.7% and 67.4% for fit patients, and 57.1% and 45.4% for frail patients, respectively. The adjusted hazard ratio for OS was 2.42 (95% CI, 1.06-5.49, p = 0.035) for frail patients compared to fit patients.
CONCLUSIONS
This finding suggested that aCGA could be used as an efficient alternative to the full CGA, potentially improving the clinical management and treatment decision-making for elderly patients with DLBCL.
目的
弥漫性大B细胞淋巴瘤（DLBCL）是最常见且侵袭性最强的非霍奇金淋巴瘤形式之一。本研究旨在评估简化综合老年评估（aCGA）在评估老年DLBCL患者的虚弱程度及预测临床结局方面的表现。
方法
前瞻性纳入2019年8月至2022年12月期间在台湾一家医疗中心新诊断为DLBCL且接受免疫化疗的91例年龄≥65岁的患者。在免疫化疗第一周期的七天内对所有参与患者进行虚弱程度评估。主要目的是比较aCGA与完整CGA在评估虚弱程度方面的准确性。次要目的包括评估虚弱程度与严重不良事件（sAE）、早期死亡率和总生存期（OS）之间的相关性。
结果
在该队列中，分别根据CGA和aCGA，有50例（55%）和38例（42%）患者被归类为虚弱。aCGA多个领域的损害与CGA多个领域的损害呈正相关。aCGA检测虚弱的受试者工作特征曲线下面积为0.846（95%置信区间[CI]，0.756 - 0.926）。aCGA领域损害≥2项提示虚弱，敏感性为70.0%，特异性为92.7%。基于aCGA，身体状况良好和虚弱患者的早期死亡率分别为7.5%和26.3%（p = 0.019）。身体状况良好患者的1年和2年总生存率分别为77.7%和67.4%，虚弱患者分别为57.1%和45.4%。与身体状况良好的患者相比，虚弱患者的总生存期调整后风险比为2.42（95% CI，1.06 - 5.49，p = 0.035）。
结论
这一发现表明aCGA可作为完整CGA的有效替代方法，可能改善老年DLBCL患者的临床管理和治疗决策。
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