老年评估对老年晚期癌症患者联合化疗耐受性的影响:配对分析

IF 2 4区 医学 Q3 ONCOLOGY Oncology Research and Treatment Pub Date : 2023-01-01 DOI:10.1159/000529097
Michael Konrad Stahl, Sebastian Willy Ertl, Pouneh Engelmeyer, Hans-Christoph Heuer, Daniel Christian Christoph
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引用次数: 1

摘要

由于他们个人的脆弱性,对老年患者的治疗决定可能很困难。老年评估(GA)可能有助于选择患者进行全身治疗,但其价值仍未得到证实。老年癌症患者(≥65岁),伴有或不伴有复杂GA,在老年肿瘤学会议上进行了讨论,这些患者在Evang接受了标准联合化疗的姑息治疗。Kliniken Essen-Mitte,回顾性评价。所有患者都口头告知了治疗方案,并在支持治疗的同时选择了化疗。为了减少选择偏差,采用倾向-得分匹配方法。比较2011-2013年(无GA组,第1组)和2014-2015年(有GA组,第2组)治疗的患者组的不同毒性终点。该研究的主要终点被定义为在一线化疗期间意外入院或死亡的患者数量,GA应将这些事件减少15%。两组共对114例患者进行了评估。中位年龄为74岁。患者患有胃肠道癌(47%)、肺癌(28%)、乳腺癌(12%)和其他类型的癌症(3%)。因此,大多数患者接受铂类(41%)、氟嘧啶类(35%)或蒽环类(13%)联合化疗。在第2组中,所有毒性终点的事件数值较低。1组患者需要提前停止治疗的比例为54.4%,而2组为29.8% (p < 0.01), 2组治疗相关死亡率也显著降低(17.5%比5.3%;P = 0.04)。主要终点,非计划住院率和死亡率分别为49.1%和35.1%(差14.0%),未达到15%的预定边界。GA组的总生存期获益不显著(22.6个月vs 18.4个月)。GA似乎有助于更好地选择老年晚期癌症患者进行联合化疗。化疗期间死亡率的显著降低证明了需要付出的努力和费用是合理的。为了评估GA对总生存期的影响,需要进行前瞻性试验。
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Impact of Geriatric Assessment on the Tolerability of Combination Chemotherapy in Older Patients with Advanced Cancer: A Matched-Pair Analysis.

Because of their individual vulnerabilities, treatment decisions for older patients can be difficult. Geriatric assessment (GA) may help to select patients for systemic treatment, but its value is still unproven. Older cancer patients (≥65 years of age) with and without complex GA followed by discussion in the geriatric-oncologic conference, who had been treated in palliative intention with standard combination chemotherapy at the Evang. Kliniken Essen-Mitte, were retrospectively evaluated. All patients had been orally informed about the treatment options and had chosen chemotherapy beside supportive care. To reduce selection bias, the method of propensity-score matching was performed. Patient groups treated in the years 2011-2013 (without GA, group 1) and in the years 2014-2015 (with GA, group 2) were compared regarding different toxicity endpoints. The primary endpoint of the study was defined as numbers of patients with unplanned admission to the hospital or death during first-line chemotherapy and GA should reduce these events by 15%. Overall, 114 patients were evaluated in both groups. The median age was 74 years. Patients suffered from gastrointestinal carcinomas (47%), lung cancer (28%), breast cancer (12%), and other cancer types (3%). Consequently, most patients were treated with platinum-based (41%), fluoropyrimidine-based (35%), or anthracycline-based (13%) combination chemotherapy. In group 2, the events were numerically lower for all toxicity endpoints. The need for a premature stop of treatment was 54.4% in group 1 compared to 29.8% in group 2 (p < 0.01) and also the treatment-related mortality was significantly lower in group 2 (17.5% vs. 5.3%; p = 0.04). The primary endpoint, the rate of unplanned hospital admission, and death was 49.1% versus 35.1% (difference 14.0%), which did not reach the predefined border of 15%. There was a nonsignificant overall survival benefit in the group with GA (22.6 vs. 18.4 months). GA appears useful to better select older patients with advanced cancer for combination chemotherapy. The significant reduction of mortality during chemotherapy justifies the efforts and costs which need to be expended. To evaluate the effect of GA on overall survival, prospective trials are required.

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来源期刊
CiteScore
3.20
自引率
0.00%
发文量
84
期刊介绍: With the first issue in 2014, the journal ''Onkologie'' has changed its title to ''Oncology Research and Treatment''. By this change, publisher and editor set the scene for the further development of this interdisciplinary journal. The English title makes it clear that the articles are published in English – a logical step for the journal, which is listed in all relevant international databases. For excellent manuscripts, a ''Fast Track'' was introduced: The review is carried out within 2 weeks; after acceptance the papers are published online within 14 days and immediately released as ''Editor’s Choice'' to provide the authors with maximum visibility of their results. Interesting case reports are published in the section ''Novel Insights from Clinical Practice'' which clearly highlights the scientific advances which the report presents.
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