目的:评估神经认知障碍(NCD)对70岁或以上实体癌患者12个月总死亡率的预后价值。
方法:前瞻性,观察,多中心队列。
方法:我们分析了来自ELCAPA纵向多中心观察队列的70岁或以上患者的数据,在1月31日之间进行新的癌症治疗方式之前进行老年评估(GA),2007年12月29日,2017.我们在四类中定义了基线NCD:无NCD,轻度NCD,中度非传染性疾病,和主要的NCD,根据简易精神状态检查(MMSE)成绩,记忆抱怨,和日常生活工具活动(IADL)评分。
方法:我们根据NCD类别比较了患者的基线特征,全局和成对(带有Bonferroni\'校正)。通过使用单变量然后多变量12个月生存分析来分析NCD类别的预后值,以年龄为时间变量,并且有或没有调整治疗策略(治愈,姑息性或排他性支持性护理)。
结果:纳入2784例实体癌患者,中位数[四分位数范围]年龄为82[78;86]。36%的患者无NCD,34%有轻度NCD,17%有中度非传染性疾病,13%有严重的非传染性疾病。我们确定了以下12个月总死亡率的独立预后因素:NCD(主要NCD的校正风险比(aHR)[95%置信区间(CI)]=1.54[1.19-1.98](p<0.001),癌症的类型,转移状态,住院会诊,一般健康状况差(评估为疲劳程度和东部肿瘤协作组表现状况[ECOG-PS]),更大的体重减轻,姑息治疗,和独家支持性护理。对治疗策略的额外调整并未显著改变主要非传染性疾病与12个月总死亡率的关联强度(HR[95CI]=1.78[1.39-2.29](p<0.001)。
结论:我们的结果表明,主要NCD的存在具有直接的预后价值(与其他老年因素无关,癌症的类型和治疗策略)在患有实体癌的老年患者中。
OBJECTIVE: To assess the prognostic value of neurocognitive disorder (NCD) for 12 month-overall mortality in patients aged 70 or more with a solid cancer.
METHODS: prospective, observational, multicenter cohort.
METHODS: We analyzed data from the ELCAPA longitudinal multicenter observational cohort of patients aged 70 or over, referred for a geriatric assessment (GA) before a new cancer treatment modality between January 31st, 2007, and December 29th, 2017. We defined the baseline NCD in four classes: no NCD, mild NCD, moderate NCD, and major NCD, based on the Mini-Mental State Examination (MMSE) score, memory complaint, and the Instrumental Activities of Daily Living (IADL) score.
METHODS: We compared the baseline characteristics of patients according to NCD classes, globally and by pairs (with Bonferroni\' correction). Prognosis value of NCD classes were analysed by using univariable and then multivariable 12 month survival analysis with age as time-variable and with and without adjustement for the treatment strategy (curative, palliative or exclusive supportive care).
RESULTS: 2784 patients with solid-cancer were included, with a median [interquartile range] age of 82 [78;86]. 36% of the patients were free of NCD, 34% had a mild NCD, 17% had a moderate NCD, and 13% had a major NCD. We identified the following independent prognostic factors for 12 month-overall mortality: NCD (adjusted hazard ratio (aHR) [95% confidence interval (CI)] for a major NCD = 1.54 [1.19-1.98] (p < 0.001), type of cancer, metastatic status, inpatient consultation, poor general health (assessed as the level of fatigue and Eastern Cooperative Oncology Group performance status [ECOG-PS]), greater weight loss, palliative treatment, and exclusive supportive care. Additional adjustment for the treatment strategy did not greatly change the strength of the association of a major NCD with 12 month-overall mortality (HR [95%CI] = 1.78 [1.39-2.29] (p < 0.001).
CONCLUSIONS: Our results suggest that the presence of a major NCD has direct prognostic value (independently of other geriatric factors, the type of cancer and the treatment strategy) in older patients with a solid cancer.