两种老年综合评估方法在老年急性髓系白血病中评价预后价值的比较

The prognostic effects of two comprehensive geriatric assessment methods in elderly patients with acute myeloid leukemia

目的比较两种老年综合评估(CGA)方法(IACA和FIL-CGA)在评价老年急性髓系白血病(AML)患者预后中的价值。方法纳入97例2008年8月至2019年12月在北京医院初诊的AML患者(≥60岁)。对其进行两种老年综合评估,一种是北京医院提出的IACA评估系统,评价指标包括工具性日常生活活动功能评定量表(IADL),年龄(Age),Charlson合并症指数(CCI),血清白蛋白(Albumin)。另一种为意大利淋巴瘤基金会(FIL)提出的简易老年综合评估系统(FIL-CGA),评价指标包括日常生活活动功能评定量表(ADL),IADL,年龄以及改良老年疾病累计评分表(MCIRS-G)。比较两种老年评估系统在判断预后方面的价值。结果97例患者中有54例接受标准化疗,16例接受地西他滨治疗,2例接受靶向治疗,25例接受最佳支持治疗。72例接受治疗的患者经IACA分组后适合、不适合、脆弱组总反应率(ORR)分别为67.7%、33.3%、0(P=0.001);FIL-CGA分组后3组ORR分别为52.5%、41.7%、35.0%(P=0.418)。全部患者经IACA分组后,3组1年总生存(OS)率分别为78.7%、27.7%、0(P<0.01),各组间1年OS率差异均有统计学意义;FIL-CGA分组后,3组1年OS率分别为67.8%、28.2%、13.9%(P<0.01),不适合组与脆弱组1年OS率差异无统计学意义(P=0.111)。IACA 3组患者早期病死率分别为0、6.0%、28.6%(P=0.005),FIL-CGA 3组早期病死率分别为2.3%、5.9%、13.9%(P=0.123)。结论与FIL-CGA相比,IACA可以更好地预测老年AML患者治疗反应率、早期病死率及生存率。

Objective To evaluate the prognostic effects of two comprehensive geriatric assessment(CGA)methods in elderly patients with acute myeloid leukemia(AML).Methods Ninety-seven patients with newly diagnosed AML at Beijing Hospital from August 2008 to December 2019 were included(≥60 years old).All patients were evaluated by two methods of CGA.One was IACA index proposed by Beijing Hospital,including instrumental activities of daily living(IADL),age,Charlson comorbidity index(CCI),albumin;the other was proposed by Italian FIL study group(FIL-CGA),including activities of daily living(ADL),IADL,age,and modified cumulative illness rating score for geriatrics(MCIRS-G).Results Among 97 patients,54 patients received standard chemotherapy,16 with decitabine,2 with targeted therapy and 25 with the best supportive therapy.The overall response rate(ORR)in 72 treated patients were 67.7%,33.3%and 0 respectively in fit,unfit and frail groups according to IACA index(P=0.001).Based on FIL-CGA,the ORRs of fit,unfit and frail groups were 52.5%,41.7%and 35.0%respectively(P=0.418).The 1-year OS rates of fit,unfit and frail groups regarding IACA method were 78.7%,27.7%and 0 respectively(P<0.01).The 1-year OS rates of fit,unfit and frail groups regarding FIL-CGA method were 67.8%,28.2%and 13.9%respectively(P<0.01),while no significant difference was seen between unfit group and frail group(P=0.111).The early death rates of fit,unfit and frail groups by IACA were 0,6.0%and 28.6%respectively(P=0.006),while those by FIL-CGA were 2.3%,5.9%,13.9%respectively(P=0.123).Conclusion Compared with FIL-CGA method,IACA predicts more effectively the treatment response,survival and early mortality in elderly patients with AML.