Development of a geriatric vulnerability score in elderly patients with advanced ovarian cancer treated with first-line carboplatin: a GINECO prospective trial
Development of a geriatric vulnerability score in elderly patients with advanced ovarian cancer treated with first-line carboplatin: a GINECO prospective trial
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DOI：
10.1093/annonc/mdt360
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发表时间：
2013-11-01
影响因子：
50.5
通讯作者：
Freyer, G.
中科院分区：
文献类型：
--
作者：
Falandry, C.;Weber, B.;Freyer, G.
GINECO先前在晚期卵巢癌（AOC）患者中进行的两项老年特异性研究强调了老年协变量对总生存期（OS）的预后价值。这项开放标签前瞻性试验旨在确定老年协变量对接受一线卡铂治疗的≥ 70岁AOC患者OS的影响。111例患者的老年协变量包括中位年龄79岁（≥ 80岁：41%）;体力状态（PS）≥ 2：47%; ≥ 3种主要合并症：24%; ≥ 4种合并症：68%;日常生活活动（ADL）评分< 6：55%;工具性日常生活活动（IADL）评分< 25：69%;医院焦虑和抑郁量表（HADS）> 14：37%。中位OS为17.4个月。总体而言，74%的患者完成了6个计划的化疗周期。3-4级血液学毒性反应常见（50%），但可管理。3-4级非血液学毒性包括疲乏（15%）、厌食（12%）、感染（9%）和血栓形成（2%）。开发了存活评分= exp（0.327*GVS），其中老年脆弱性评分（GVS）是以下各项的总和（各自赋值为1）：白蛋白血症< 35 g/l; ADL评分< 6; IADL评分< 25;淋巴组织减少< 1 G/l;和HADS > 14。当临界值>= 3时，GVS区分了OS、治疗完成率、严重不良事件和计划外住院率显著不同的两组。GVS是治疗老年AOC人群时识别弱势患者的有价值工具。
Two previous GINECO elderly specific studies in advanced ovarian cancer (AOC) patients highlighted the prognostic value of geriatric covariates for overall survival (OS).This open-label prospective trial was designed to identify the impact of geriatric covariates on OS in AOC patients >= 70 years treated with first-line carboplatin.Geriatric covariates of the 111 patients included median age 79 years (>= 80 years: 41%); performance status (PS) >= 2: 47%; >= 3 major comorbidities: 24%; >= 4 comedications: 68%; activities of daily living (ADL) score < 6: 55%; instrumental activities of daily living (IADL) score < 25: 69%; Hospital Anxiety and Depression Scale (HADS) > 14: 37%. The median OS was 17.4 months. Overall, 74% of patients completed the six planned chemotherapy cycles. Grade 3-4 haematological toxic effects were frequent (50%) but manageable. Grade 3-4 non-haematological toxicities included fatigue (15%), anorexia (12%), infections (9%) and thrombosis (2%). A survival score = exp(0.327*GVS) was developed, where the geriatric vulnerability score (GVS) is the sum of the following (each assigned a value of one): albuminaemia < 35 g/l; ADL score < 6; IADL score < 25; lymphopaenia < 1 G/l; and HADS > 14. With a cut-off >= 3, GVS discriminated two groups with significantly different OS, treatment completion, severe adverse events and unplanned hospital admissions rates.The GVS is a valuable tool for identifying vulnerable patients when treating an elderly AOC population.