Predicting the risk of chemotherapy toxicity in older patients: The Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score
Predicting the risk of chemotherapy toxicity in older patients: The Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score
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DOI：
10.1002/cncr.26646
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发表时间：
2012-07-01
期刊：
影响因子：
6.2
通讯作者：
Balducci, Lodovico
中科院分区：
文献类型：
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作者：
Extermann, Martine;Boler, Ivette;Balducci, Lodovico
背景：缺乏评估化疗严重毒性的个体风险的工具。这种工具对老年患者特别有用，因为他们的健康状况和功能储备差异很大。方法：作者对开始化疗的70岁患者进行了一项前瞻性的多中心研究。根据不良事件通用术语标准3.0版，4级血液毒性(H)或3/4级非血液毒性(NH)被定义为严重。对24项参数进行了评估。调整化疗方案(Chemotox)的毒性，使用一个指数来估计每个患者的平均化疗毒性风险(Max2指数)。总共有562名患者被累积，518名患者可评估，并被随机分为派生队列和验证队列。结果：严重毒副反应发生率为%。高龄患者化疗风险评估量表(CRASH)评分由H毒性和NH毒性两个子评分构成。H毒性的预测因素是淋巴细胞、天冬氨酸氨基转移酶水平、日常生活能力评分、乳酸脱氢酶水平、舒张压和Chemotox。最好的模型包括后4个预测因子(风险类别：低风险，分别为7%；中低风险，23%；中高风险，54%；高风险，100%；P趋势；.001)。NH毒性的预测因素有：血红蛋白、肌酐清除量、白蛋白、自评健康状况、东部合作肿瘤组表现、简易精神状态评分、微型营养评估评分和Chemotox。后4个预测因子提供了最好的模型(风险类别分别为33%、46%、67%和93%；P趋势和.001)。合并后的风险类别分别为50%、58%、77%和79%；Bootstrap内部验证和独立样本验证证明了稳定的风险分类和P趋势。结论：CRASH评分区分了严重毒性的几个风险级别。分割分数的区分性要好于综合分数。据作者所知，这是系统地综合了老年患者的化疗和患者风险的第一个评分，具有未来临床应用的潜力。癌症2011年。(C)2011年美国癌症协会。
BACKGROUND: Tools are lacking to assess the individual risk of severe toxicity from chemotherapy. Such tools would be especially useful for older patients, who vary considerably in terms of health status and functional reserve. METHODS: The authors conducted a prospective, multicentric study of patients aged =70 years who were starting chemotherapy. Grade 4 hematologic (H) or grade 3/4 nonhematologic (NH) toxicity according to version 3.0 of the Common Terminology Criteria for Adverse Events was defined as severe. Twenty-four parameters were assessed. Toxicity of the regimen (Chemotox) was adjusted using an index to estimate the average per-patient risk of chemotherapy toxicity (the MAX2 index). In total, 562 patients were accrued, and 518 patients were evaluable and were split randomly (2:1 ratio) into a derivation cohort and a validation cohort. RESULTS: Severe toxicity was observed in 64% of patients. The Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) score was constructed along 2 subscores: H toxicity and NH toxicity. Predictors of H toxicity were lymphocytes, aspartate aminotransferase level, Instrumental Activities of Daily Living score, lactate dehydrogenase level, diastolic blood pressure, and Chemotox. The best model included the 4 latter predictors (risk categories: low, 7%; medium-low, 23%; medium-high, 54%; and high, 100%, respectively; Ptrend < .001). Predictors of NH toxicity were hemoglobin, creatinine clearance, albumin, self-rated health, Eastern Cooperative Oncology Group performance, Mini-Mental Status score, Mini-Nutritional Assessment score, and Chemotox. The 4 latter predictors provided the best model (risk categories: 33%, 46%, 67%, and 93%, respectively; Ptrend < .001). The combined risk categories were 50%, 58%, 77%, and 79%, respectively; Ptrend < .001). Bootstrap internal validation and independent sample validation demonstrated stable risk categorization and Ptrend < .001. CONCLUSIONS: The CRASH score distinguished several risk levels of severe toxicity. The split score discriminated better than the combined score. To the authors' knowledge, this is the first score systematically integrating both chemotherapy and patient risk for older patients and has a potential for future clinical application. Cancer 2011. (c) 2011 American Cancer Society.