老年综合评估在7O岁以上弥漫大B细胞淋巴瘤患者中应用的研究

The effect of comprehensive geriatric assessment on the therapeutic decision-makingin elderly patients with diffuse large B-cell lymphoma

目的探讨老年综合评估在老年弥漫大B细胞淋巴瘤患者中判断是否适合标准剂量治疗的可行性。方法前瞻性研究。选取综合老年评估包含的3个评分量表：日常活动功能量表、工具性日常活动功能量表、改良老年疾病累计评分表对老年患者进行评估。以评估得分和患者年龄为标准，将我院收治的年龄70岁及以上弥漫大B细胞淋巴瘤患者37例分为适合组、不适合组、脆弱组。治疗方案不以老年综合评估分组为标准，仍由临床医师根据临床经验及患者疾病特点决定。评价3组治疗有效率及总生存期。结果37例年龄大于70岁的弥漫大B细胞淋巴瘤患者，分为适合组21例（56．8％），不适合组7例（18．9％），脆弱组9例（24．3％）。37例患者共化疗213个疗程，人均5．76个疗程。治疗总有效率（完全缓解＋部分缓解）为64．9％（24／37），适合组、不适合组、脆弱组3组总有效率分别为85．7％（18／21）、28．6％（2／7）、44．4％（4／9），差异有统计学意义（χ^2=9．69，P=0．008）。37例患者中位随访时间24个月（1～60个月），适合组、不适合组和脆弱组中位生存时间分别为44个月、10个月和9个月，3组比较差异有统计学意义（χ^2=7．03，P=0．03）。适合组21例患者中12例接受标准剂量治疗，总有效率100％（12／12），9例降低剂量治疗，总有效率66．7％（6／9），差异无统计学意义（P=0．06）。标准剂量治疗患者2年生存率83．3％（10／12），降低剂量治疗患者2年生存率33．3％（3／9），差异有统计学意义（P=0．032），而血液学毒副反应差异无统计学意义。结论综合老年评估对老年弥漫大B细胞淋巴瘤患者的治疗决策具有一定的指导意义，适合标准剂量治疗患者接受标准剂量治疗可获得满意疗效。

Objective To evaluate the feasibility of using comprehensive geriatric assessment （CGA） in estimating if standard dose treatment is fit for the elderly patients with diffuse large B cell lymphoma. Methods ： Comprehensive geriatric assessments including three assessments of activity of daily living, instrumental activity of daily living and comorbidity scoring according to Cumulative Illness Rating Score for Geriatrics were adopted to assess if standard dose treatment is fit for the elderly patients in our prospective study. Thirty seven patients with diffuse large B cell lymphoma, aged ）70 years were enrolled in the study, and grouped into fit, unfit and frail groups according to comprehensive geriatric assessment scoring and their age. The treatment protocolswere not determined by comprehensive geriatric assessment scores, but by clinical judgments made by clinicians based on their clinical experience and disease features. The clinically effective response and overall survival （OS） were analyzed in the three groups. Results According to CGA scores, patients were grouped into ＂fit＂（21 cases （56.8%）], ＂unfit＂ [7（18.9%）] and ＂frail＂ [9（24.3%）]. 37 cases received 213 courses of treatment at average 5.76 courses per case. The overall response （complete / partial remission） rates were [85.7%（18/21） vs. 28.6% （2/7） vs. 44.4% （4/9）, χ^2=9.69, P=0.0083 and median survival times were （44 months vs. 10 months vs. 9 months;χ^2=7.03, P=0.03） among ＂fit＂, ＂unfit＂ and ＂frail＂ groups with statistically significant differences. Total effective rate （achieving all clinical targets） in ＂fit＂ group of 21 cases were 100% （12/12）with receiving standard dose therapy,and 66.7% of（6/9） with low dose therapy （P = 0.06 ）. Overall response rate （ total/partial remission） [85.7%（18/21） vs. 28.6%（2/7） vs. 44.4%（4/9）,χ^2=9.69,P=0. g083 and median survival （44 months vs. 10 months vs. 9 months; χ^2= 7.03,P= 0.03） among＂fit＂, ＂unfit＂ and ＂frail＂ groups. In ＂fit＂ group, the two-year overall survival was higher in patients receiving standard dose treatment than receivingpalliativetreatment, with statistical significance [83.3% （10/12） vs. 33.3% （3/9）, P = 0. 032], without significant hematologic toxicity observed between the subgroups. Conclusions Comprehensive geriatric assessment can identify if elderly patients diffuse large B cell lymphoma can acquire a satisfactory curative effect from a standard dose treatment of immunochemotherapy.