Abstract：
Prognostic information is needed to balance benefits and risks of cancer treatment in older patients. Metabolomics-based scores were previously developed to predict 5- and 10-year mortality (MetaboHealth) and biological age (MetaboAge). This study aims to investigate the association of MetaboHealth and MetaboAge with 1-year mortality in older patients with solid tumors, and to study their predictive value for mortality in addition to established clinical predictors. This prospective cohort study included patients aged ≥ 70 years with a solid malignant tumor, who underwent blood sampling and a geriatric assessment before treatment initiation. The outcome was all-cause 1-year mortality. Of the 192 patients, the median age was 77 years. With each SD increase of MetaboHealth, patients had a 2.32 times increased risk of mortality (HR 2.32, 95% CI 1.59-3.39). With each year increase in MetaboAge, there was a 4% increased risk of mortality (HR 1.04, 1.01-1.07). MetaboHealth and MetaboAge showed an AUC of 0.66 (0.56-0.75) and 0.60 (0.51-0.68) for mortality prediction accuracy, respectively. The AUC of a predictive model containing age, primary tumor site, distant metastasis, comorbidity, and malnutrition was 0.76 (0.68-0.83). Addition of MetaboHealth increased AUC to 0.80 (0.74-0.87) (p = 0.09) and AUC did not change with MetaboAge (0.76 (0.69-0.83) (p = 0.89)). Higher MetaboHealth and MetaboAge scores were associated with 1-year mortality. The addition of MetaboHealth to established clinical predictors only marginally improved mortality prediction in this cohort with various types of tumors. MetaboHealth may potentially improve identification of older patients vulnerable for adverse events, but numbers were too small for definitive conclusions. The TENT study is retrospectively registered at the Netherlands Trial Register (NTR), trial number NL8107. Date of registration: 22-10-2019.
摘要：
需要预后信息来平衡老年患者癌症治疗的益处和风险。以前开发了基于代谢组学的评分来预测5年和10年死亡率（MetaboHealth）和生物年龄（MetaboAge）。本研究旨在探讨MetaboHealth和MetaboAge与老年实体瘤患者1年死亡率的关系。并研究其对死亡率的预测价值以及已确定的临床预测因子。这项前瞻性队列研究包括年龄≥70岁的实体恶性肿瘤患者，在治疗开始前进行血液采样和老年评估。结果是全因1年死亡率。192名患者中,中位年龄为77岁.随着MetaboHealth的每一个SD增加，患者的死亡风险增加了2.32倍(HR2.32,95%CI1.59~3.39).随着MetaboAge的逐年增加，死亡风险增加4%(HR1.04,1.01-1.07).MetaboHealth和MetaboAge显示死亡率预测准确性的AUC为0.66（0.56-0.75）和0.60（0.51-0.68），分别。包含年龄的预测模型的AUC，原发肿瘤部位，远处转移,合并症，营养不良为0.76（0.68-0.83）。添加MetaboHealth将AUC增加到0.80（0.74-0.87）（p=0.09），并且AUC没有随MetaboAge变化（0.76（0.69-0.83）（p=0.89））。较高的MetaboHealth和MetaboAge评分与1年死亡率相关。将MetaboHealth添加到已建立的临床预测因子中，仅略微改善了该具有各种类型肿瘤的队列中的死亡率预测。MetaboHealth可能会改善对不良事件易感的老年患者的识别，但是数字太小，无法得出明确的结论。TENT研究在荷兰审判登记册（NTR）上进行了回顾性注册，试验编号NL8107。注册日期：22-10-2019。
