改良老年疾病累计评分表在肺癌患者中的应用
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摘要
背景随着人口老龄化和肿瘤发病率的上升,越来越多的老年肿瘤患者伴有合并症。国外已将合并症的评价应用于老年肿瘤患者的诊疗,但在我国尚未引起重视,缺乏相关的研究。
目的应用自行翻译引进的改良老年疾病累计评分表(Modified CumulativeIllness Rating Scale-Geriatric,MCIRS-G)研究肺癌患者合并症分布情况及其对化疗安全性的影响;研究其与KPS评分的相关性,评价该量表的临床应用价值。
方法调查对象为2006年10月至2007年9月间在安徽医科大学第一附属医院肿瘤内科住院的经病理学或细胞学确诊的非小细胞肺癌患者。年龄大于或等于65岁的患者入老年组,小于65岁者入对照组。使用自编的调查表统计患者的人口统计学特征、肿瘤及治疗相关情况。采用MCIRS-G评估合并症,KPS评估功能状态。化疗患者接受以顺铂为基础的两药联合方案,根据MCIRS-G评分、年龄及KPS评分分层研究化疗毒副反应发生率。采用线性相关分析MCIRS-G评分与KPS评分的相关性。
结果共有125例非小细胞肺癌患者入组,其中老年组75例,平均年龄为71岁(65岁～89岁):对照组50例,平均年龄为55岁(28岁～64岁)。老年组合并症患病率为84%(63/75),对照组合并症患病率为60%(30/50),差异有统计学意义(P=0.003)。最常见的合并症为高血压病和慢性呼吸系统疾病。按年龄将患者分成≤54岁、55岁～64岁、65岁～74岁、≥75岁四组,每组平均MCIRS-G评分(P=0.000)、受合并症影响的系统数目(P=0.000)和受4～5级合并症影响的系统数目(P=0.015)均随着年龄的增大而增加。107名化疗的患者,根据MCIRS-G评分分层(14分、15分～18分、≥19分)发现,恶心呕吐(P=0.007)、白细胞减少(P=0.038)、血红蛋白减少(P=0.022)、发热感染(P=0.037)和疲劳(P=0.010)的发生率显著增加。根据年龄、KPS分层未发现毒副反应发生率的差异。MCIRS-G评分与年龄呈正相关(P=0.000),与KPS评分无相关性(P=0.333)。
结论合并症对肺癌患者化疗安全性的影响比生理年龄的影响更大,根据MCIRS-G评分预测毒副反应比根据KPS评分更敏感。MCIRS-G评分高或患有4～5级合并症的患者化疗需加强监护。MCIRS-G评分与KPS评分无相关性。建议将合并症的评价纳入肿瘤临床研究,同KPS评分相互结合共同指导肿瘤患者治疗。我们翻译引进的MCIRS-G量表可作为一个合并症测量工具,适合在中国肿瘤患者中应用。
Background:With the aging of the population and rising of cancer incidence,more and more elderly cancer patients have comorbidities.Evaluation of their comorbidities has been used in the diagnosis and treatment of the elderly cancer patients abroad,but hasn't attracted attention in our country,relevant research is lacking.
Objective:To apply the Modified Cumulative Illness Rating Scale-Geriatric in Chinese version in investigating the prevalence of comorbidity and its impact on chemotherapy safety in lung cancer patients,to study the relationship beween the score of MCIRS-G and kamofsky performance score(KPS),and to evaluate the clinical application value of this scale.
Methods:A survey was undertaken on non-small cell lung cancer patients in the department of oncology,the first affiliated hospital of Anhui Medical University from the October 2006 to September 2007.All the patients had pathological or cytological diagnoses,and were divided into the elderly group(≥65 years) and the control group (＜65 years).This study uesd self-administered questionnaire containing demographic and cancer characteristics.Comorbidities were assessed with MCIRS-G.Physical status was assessed with KPS.The incidence of chemotherapy toxicity was stratified according to the score of MCIRS-G,age,KPS.Linear correlation was applied to analyze the relationship beween the score of MCIRS-G and KPS.
Results:A total of 125 cases were enrolled.There were 75 patients in the elderly group, their ages ranged from 65 to 89(mean age=71);50 patients were enrolled in the control group,their ages ranged from 28 to 64(mean age=55).63 patients had comorbidities in the elderly group(63/75),while 30 in the control group(30/50).There was a significant difference of the prevalence of comorbidity between the two groups(P=0.003).The most frequent comorbidities were hypertension and chronic respiratory diseases.With all patients divided into four groups by age:≤54,55～64,65～74,≥75,the average score of MCIRS-G(P=0.000),average number of affected organ systems(P=0.000), average number of affected organ system with severe disease(levels 4-5)(P=0.015) of each group all increased with age.With the increase of the score of MCIRS-G,the incidence of nausea and vomite(P=0.007),leucopenia(P=0.038),aglobulia(P=0.022), fever and infection(P=0.037),fatigue(P=0.010) all significantly increased in 107 cases who accepted chemotherapy.There was no change in the incidence of toxicity when stratified by age or KPS.There was good correlation between age and the score of MCIRS-G(P=0.000),no correlation between the score of MCIRS-G and KPS (P=0.333).
Conclusion:Comorbidity was the more important factor affecting chemotherapy safety of lung cancer compared to age.It was more sensitive to predict chemotherapy toxicity according the score of MCIRS-G than KPS.Intense monitoring was demanded when patients with high scores of MCIRS-G and severe disease(levels 4-5) accepted chemotherapy.There was no correlation between MCIRS-G and KPS.It was recommeded to guide the treatment of elderly caner patients using MCIRS-G and KPS together in clinical trials.This Chinese version of Modified Cumulative Illness Rating Scale-Geriatric was considered appropriate to assess comorbidities in Chinese cancer patients.
目的应用自行翻译引进的改良老年疾病累计评分表(Modified CumulativeIllness Rating Scale-Geriatric,MCIRS-G)研究肺癌患者合并症分布情况及其对化疗安全性的影响;研究其与KPS评分的相关性,评价该量表的临床应用价值。
方法调查对象为2006年10月至2007年9月间在安徽医科大学第一附属医院肿瘤内科住院的经病理学或细胞学确诊的非小细胞肺癌患者。年龄大于或等于65岁的患者入老年组,小于65岁者入对照组。使用自编的调查表统计患者的人口统计学特征、肿瘤及治疗相关情况。采用MCIRS-G评估合并症,KPS评估功能状态。化疗患者接受以顺铂为基础的两药联合方案,根据MCIRS-G评分、年龄及KPS评分分层研究化疗毒副反应发生率。采用线性相关分析MCIRS-G评分与KPS评分的相关性。
结果共有125例非小细胞肺癌患者入组,其中老年组75例,平均年龄为71岁(65岁～89岁):对照组50例,平均年龄为55岁(28岁～64岁)。老年组合并症患病率为84%(63/75),对照组合并症患病率为60%(30/50),差异有统计学意义(P=0.003)。最常见的合并症为高血压病和慢性呼吸系统疾病。按年龄将患者分成≤54岁、55岁～64岁、65岁～74岁、≥75岁四组,每组平均MCIRS-G评分(P=0.000)、受合并症影响的系统数目(P=0.000)和受4～5级合并症影响的系统数目(P=0.015)均随着年龄的增大而增加。107名化疗的患者,根据MCIRS-G评分分层(14分、15分～18分、≥19分)发现,恶心呕吐(P=0.007)、白细胞减少(P=0.038)、血红蛋白减少(P=0.022)、发热感染(P=0.037)和疲劳(P=0.010)的发生率显著增加。根据年龄、KPS分层未发现毒副反应发生率的差异。MCIRS-G评分与年龄呈正相关(P=0.000),与KPS评分无相关性(P=0.333)。
结论合并症对肺癌患者化疗安全性的影响比生理年龄的影响更大,根据MCIRS-G评分预测毒副反应比根据KPS评分更敏感。MCIRS-G评分高或患有4～5级合并症的患者化疗需加强监护。MCIRS-G评分与KPS评分无相关性。建议将合并症的评价纳入肿瘤临床研究,同KPS评分相互结合共同指导肿瘤患者治疗。我们翻译引进的MCIRS-G量表可作为一个合并症测量工具,适合在中国肿瘤患者中应用。
Background:With the aging of the population and rising of cancer incidence,more and more elderly cancer patients have comorbidities.Evaluation of their comorbidities has been used in the diagnosis and treatment of the elderly cancer patients abroad,but hasn't attracted attention in our country,relevant research is lacking.
Objective:To apply the Modified Cumulative Illness Rating Scale-Geriatric in Chinese version in investigating the prevalence of comorbidity and its impact on chemotherapy safety in lung cancer patients,to study the relationship beween the score of MCIRS-G and kamofsky performance score(KPS),and to evaluate the clinical application value of this scale.
Methods:A survey was undertaken on non-small cell lung cancer patients in the department of oncology,the first affiliated hospital of Anhui Medical University from the October 2006 to September 2007.All the patients had pathological or cytological diagnoses,and were divided into the elderly group(≥65 years) and the control group (＜65 years).This study uesd self-administered questionnaire containing demographic and cancer characteristics.Comorbidities were assessed with MCIRS-G.Physical status was assessed with KPS.The incidence of chemotherapy toxicity was stratified according to the score of MCIRS-G,age,KPS.Linear correlation was applied to analyze the relationship beween the score of MCIRS-G and KPS.
Results:A total of 125 cases were enrolled.There were 75 patients in the elderly group, their ages ranged from 65 to 89(mean age=71);50 patients were enrolled in the control group,their ages ranged from 28 to 64(mean age=55).63 patients had comorbidities in the elderly group(63/75),while 30 in the control group(30/50).There was a significant difference of the prevalence of comorbidity between the two groups(P=0.003).The most frequent comorbidities were hypertension and chronic respiratory diseases.With all patients divided into four groups by age:≤54,55～64,65～74,≥75,the average score of MCIRS-G(P=0.000),average number of affected organ systems(P=0.000), average number of affected organ system with severe disease(levels 4-5)(P=0.015) of each group all increased with age.With the increase of the score of MCIRS-G,the incidence of nausea and vomite(P=0.007),leucopenia(P=0.038),aglobulia(P=0.022), fever and infection(P=0.037),fatigue(P=0.010) all significantly increased in 107 cases who accepted chemotherapy.There was no change in the incidence of toxicity when stratified by age or KPS.There was good correlation between age and the score of MCIRS-G(P=0.000),no correlation between the score of MCIRS-G and KPS (P=0.333).
Conclusion:Comorbidity was the more important factor affecting chemotherapy safety of lung cancer compared to age.It was more sensitive to predict chemotherapy toxicity according the score of MCIRS-G than KPS.Intense monitoring was demanded when patients with high scores of MCIRS-G and severe disease(levels 4-5) accepted chemotherapy.There was no correlation between MCIRS-G and KPS.It was recommeded to guide the treatment of elderly caner patients using MCIRS-G and KPS together in clinical trials.This Chinese version of Modified Cumulative Illness Rating Scale-Geriatric was considered appropriate to assess comorbidities in Chinese cancer patients.
引文
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16. Firat S, Bousamra M, Gore E, et al. Comorbidity and KPS are independent prognostic factors in stage I non-small-cell lung cancer[J]. Int J Radiat Oncol Biol Phys, 2002; 52(4): 1047-57
17. Repetto L, Fratino L, Audisio RA, et al. Comprehensive geriatric assessment adds information to Eastern Cooperative Oncology Group performance status in elderly cancer patients: an Italian Group for Geriatric Oncology Study[J]. J Clin Oncol, 2002; 20(2): 494-02
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2.Balducci L.Management of cancer in the elderly[J].Oncol,2006;20(2):135-43
3.Gridelli C,Maione P,Comunale D,et al.Adjuvant chemotherapy in elderly patients with non-small-cell lung cancer[J].Cancer Control,2007;14(1):57-62
4.Hurria A,Kris MG.Management of lung cancer in older adults[J].CA Cancer J Clin,2003;53(6):325-41
5.Chen H,Cantor A,Meyer J,et al.Can older cancer patients tolerate chemotherapy? A prospective pilot study[J].Cancer,2003;97(4):1107-14
6.Balducci L,Cohen HJ,Engstrom PF,et al.Senior adult oncology clinical practice guidelines in oncology[J].J Natl Compr Canc Netw,2005;3(4):572-90
7.Burdette-Radoux S,Muss HB.Adjuvant chemotherapy in the elderly:whom to treat,what regimen[J]? Oncologist,2006;11(3):234-42
8.Yancik R.Cancer burden in the aged:an epidemiologic and demographic overview[J].Cancer,1997;80(7):1273-83
9.Seo PH,Pieper CF,Cohen HJ.Effects of cancer history and comorbid conditions on mortality and healthcare use among older cancer survivors[J].Cancer,2004;101(10):2276-84
10.Castro MA,Dedivitis RA,Ribeiro KC.Comorbidity measurement in patients with laryngeal squamous cell carcinoma[J].ORL J Otorhinolaryngol Relat Spec,2007;69(3):146-52
11.Hutchins LF,Unger JM,Crowley JJ,et al.Underrepresentation of patients 65 years of age or older in cancer-treatment trials[J].N Engl J Med,1999;341(27):2061-67
12.Linn BS,Linn MW,Gurel L.Cumulative illness rating scale[J].J Am Geriatr Soc,1968;16(5):622-26
13. Miller MD, Paradis CF, Houck PR, et al. Rating chronic medical illness burden in geropsychiatric practice and research: application of the cumulative illness rating scale[J]. Psychiatry Res, 1992; 41(3): 237-48
14. Hudon C, Fortin M, Soubhi H. Abbreviated guidelines for scoring the Cumulative Illness Rating Scale (CIRS) in family practice[J]. J Clin Epidemiol, 2007; 60(2): 212
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