Geriatric Assessment and Frailty Scores Predict Mortality in Myeloma: Systematic Review and Meta-analysis.
Geriatric Assessment and Frailty Scores Predict Mortality in Myeloma: Systematic Review and Meta-analysis.
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老年评估和衰弱评分预测骨髓瘤死亡率：系统评价和荟萃分析。
DOI：
10.1016/j.clml.2019.04.014
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Wildes,TanyaM
中科院分区：
文献类型：
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作者：
Salazar,AnaS;Recinos,LuisaM;Mian,HiraS;Stoll,Carolyn;Simon,LauraE;Sekhon,Subhjit;Colditz,GrahamA;Wildes,TanyaM
多发性骨髓瘤的发病率随着老年人比例的迅速增长而增加。需要对现有证据进行严格评估，以指导老年骨髓瘤患者的管理。进行了一项系统回顾，以报告老年评估和虚弱评分在老年多发性骨髓瘤患者中的预后价值。我们在2018年2月和8月进行了文献检索。两名研究人员提取了数据并评估了研究的质量。老年评估和虚弱评分定义为至少评价2个老年领域的评分。主要结局为死亡率或毒性。我们使用随机效应模型估计了合并风险比（HR）和95%置信区间（CI）。我们筛选了1672篇引文的标题和摘要。7项研究被纳入定性分析，其中3项被纳入荟萃分析。两项研究报告，与体弱患者相比，中度健康患者和体弱患者发生血液学不良事件的风险相似，但与健康患者相比，体弱患者发生非血液学不良事件的风险显著增加。在荟萃分析中，在日常生活活动评分≤ 4的患者中观察到死亡的HR显著增加（汇总HR = 1.576; 95% CI，1.051-2.102; χ2= 0.87;P= 0.647;I2= 0）。虚弱患者的死亡风险高于健康患者（合并HR = 2.169; 95% CI，1.002-2.336; χ2= 3.02;P= 0.221;I2= 33.7%）。GA和虚弱评分可有效预测老年骨髓瘤患者的死亡率。
The incidence of multiple myeloma is increasing as the proportion of older adults is growing rapidly. A critical evaluation of the evidence available is needed to guide the management of older patients with myeloma. A systematic review was conducted to report the prognostic value of geriatric assessment and frailty scores in older patients with multiple myeloma. We conducted a literature search in February and August 2018. Two researchers extracted the data and assessed the quality of the studies. Geriatric assessment and frailty scores were defined as those evaluating at least 2 geriatric domains. Main outcomes were mortality or toxicity. We estimated the pooled hazard ratios (HR) with 95% confidence intervals (CIs) using a random-effects model. We screened titles and abstracts of 1672 citations for eligibility. Seven studies were included in the qualitative analysis, of which 3 were included in the meta-analysis. Two studies reported similar risks of hematologic adverse events in intermediate-fit and in frail patients compared to frail, but a significantly increased risk of nonhematologic adverse events in frail patients compared to fit patients. In meta-analysis, a significantly increased HR for death was observed in patients with activity of daily living score ≤ 4 (pooled HR = 1.576; 95% CI, 1.051-2.102; χ2= 0.87;P= .647;I2= 0). Patients classified as frail showed higher risk of death than fit patients (pooled HR = 2.169; 95% CI, 1.002-2.336; χ2= 3.02;P= .221;I2= 33.7%). GA and frailty score are effective in predicting mortality in older adults with myeloma.