Impact of Preoperative Social Frailty on Overall Survival and Cancer-Specific Survival among Older Patients with Gastrointestinal Cancer
Impact of Preoperative Social Frailty on Overall Survival and Cancer-Specific Survival among Older Patients with Gastrointestinal Cancer
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术前社交脆弱对老年胃肠癌患者总体生存率和癌症特异性生存率的影响
DOI：
10.1016/j.jamda.2021.03.025
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发表时间：
2021
影响因子：
7.6
通讯作者：
Sakai Yoshitada
中科院分区：
文献类型：
--
作者：
Ono Rei;Makiura Daisuke;Nakamura Tetsu;Okumura Maho;Fukuta Akimasa;Saito Takashi;Inoue Junichiro;Oshikiri Taro;Kakeji Yoshihiro;Sakai Yoshitada
目的虚弱是一种多维综合征。然而，肿瘤诊所使用的典型虚弱量表评估身体损伤和/或营养不良，但不考虑社会领域。我们的研究旨在阐明老年胃肠道肿瘤患者术前社会脆弱与总生存（OS）和癌症特异性生存（CSS）之间的关系。这是一项前瞻性队列研究。背景和参与者这项单中心研究招募了195名年龄在60岁至60岁之间的胃肠癌患者，这些患者计划接受治疗性手术。方法考虑手术的OS和CSS。主要相关因素包括虚弱，定义为老年8分≤14分；社交脆弱被定义为以下两种或两种以上的情况——不经常外出，很少拜访朋友，感觉对朋友或家人没有帮助，独自生活，不与某人每天交谈，以及它们的组合[没有社交脆弱（- / -），没有社交脆弱（+/ -），没有社交脆弱（- /+），没有社交脆弱（- /+），以及社交脆弱（+/+）]。我们使用Cox比例风险模型和Fine and Gray比例亚分布风险模型来调整混杂因素。结果195例患者中，181例（平均年龄72.0岁）纳入分析。中位随访时间为994天。社会脆弱性（风险比3.10）及其组合[6.35；虚弱伴社会衰弱（+/+）vs无虚弱伴社会衰弱（- /−）]是OS的显著预测因子。社会脆弱（亚分布风险比3.23）及其组合（7.57）是CSS的显著预测因子。结论和意义术前社会衰弱是老年胃肠道肿瘤患者OS和CSS的预测因子。筛查老年癌症患者的社会脆弱性、脆弱性及其组合非常重要。
ObjectivesFrailty is a multidimensional syndrome. However, typical frailty scales used in oncology clinics assess physical impairment and/or malnutrition but do not consider the social domain. Our study aimed to clarify the relationship between preoperative social frailty and overall survival (OS) and cancer-specific survival (CSS) among older patients with gastrointestinal cancer.DesignThis was a prospective cohort study.Setting and ParticipantsThis single-center study recruited 195 patients with gastrointestinal cancer scheduled for curative surgery and aged >60 years.MethodsThe outcomes considered were the OS and CSS of surgery. Primary associated factors included frailty defined as a Geriatric 8 score ≤14; social frailty defined as 2 or more of the following—going out less frequently, rarely visiting friends, feeling unhelpful to friends or family, living alone, and not talking with someone daily, and combinations therein [no frailty without social frailty (−/−), frailty without social frailty (+/−), no frailty with social frailty (−/+), and frailty with social frailty (+/+)]. We used the Cox proportional hazards model and the Fine and Gray proportional subdistribution hazard model adjusting for confounding factors.ResultsOf the 195 patients, 181 (mean age, 72.0 years) were included for analysis. The median follow-up time was 994 days. Social frailty (hazard ratio 3.10) and their combinations [6.35; frailty with social frailty (+/+) vs no frailty without social frailty (−/−)] were significant predictors of OS. Social frailty (subdistribution hazard ratio 3.23) and their combinations (7.57) were significant predictors of CSS.Conclusions and ImplicationsPreoperative social frailty is a predictor of OS and CSS in older patients with gastrointestinal cancer. Screening for social frailty, frailty, and their combinations in older patients with cancer is important.