4种衰弱评估工具在老年结直肠癌患者术前评估中的应用比较

Comparison of four frailty assessment tools in preoperative assessment of elderly colorectal cancer patients

目的比较衰弱表型、衰弱筛查量表(FS)、临床衰弱量表(CFS)以及埃德蒙顿衰弱量表(EFS)评估老年结直肠癌患者术前衰弱的一致性及其对术后并发症发生风险的预测效能,以期为护理人员选择合适的衰弱评估工具提供参考。方法采用便利抽样法,选取2020年12月—2021年10月在苏州大学附属第一医院普外科行结直肠癌根治术的207例老年患者为研究对象,采用衰弱表型、FS、CFS以及EFS对其进行衰弱评估;以术后并发症发生为结局指标,采用受试者工作特征(ROC)曲线和Bayes判别分析比较4种衰弱评估工具的预测效能。结果207例老年结直肠癌患者中衰弱表型、FS、CFS、EFS的衰弱检出率分别为19.8%(41/207)、11.6%(24/207)、22.2%(46/207)、10.1%(21/207)。衰弱表型、FS、CFS、EFS的ROC曲线下面积分别为0.714、0.643、0.737、0.665(P均<0.01);进一步两两比较发现,衰弱表型与FS、FS与CFS、CFS与EFS的ROC曲线下面积差值,差异有统计学意义(P<0.05)。衰弱表型、FS、CFS、EFS对老年结直肠癌患者术后并发症发生风险预测的交叉验证准确率分别为78.7%、68.6%、76.3%、75.8%。结论衰弱表型与CFS对老年结直肠癌患者术后并发症发生有中等强度的预测效能,且两者预测效能无差异,CFS与衰弱表型均可以用于老年结直肠癌患者术前衰弱评估,但考虑临床适用性,推荐使用CFS。

Objective To compare the consistency of preoperative frailty assessment in elderly colorectal cancer patients using Frailty Phenotype(FP),FRAIL Scale(FS),Clinical Frailty Scale(CFS),and Edmonton Frailty Scale(EFS),and their predictive performance in predicting the postoperative complication,so as to provide reference for nurses to choose appropriate frailty assessment tools.MethodsFrom December 2020 to October 2021,207 elderly patients who underwent radical surgery for colorectal cancer at the General Surgery of the First Affiliated Hospital of Soochow University were selected as the study subject by convenience sampling.FP,FS,CFS,and EFS were used to assess patients'frailty.Taking postoperative complications as the outcome indicator,the predictive performance of four frailty assessment tools was compared using the receiver operating characteristic(ROC)curve and Bayes discriminant analysis.ResultsThe frailty detection rates of FP,FS,CFS,and EFS in 207 elderly colorectal cancer patients were 19.8%(41/207),11.6%(24/207),22.2%(46/207),and 10.1%(21/207),respectively.The areas under the ROC curves of FP,FS,CFS,and EFS were 0.714,0.643,0.737,and 0.665,respectively,with statistically significant differences(all P<0.01).Pairwise comparison found that there were statistically significant differences in the area under the ROC curve between FP and FS,FS and CFS,CFS and EFS(P<0.05).The cross validation accuracy of FP,FS,CFS and EFS in predicting the postoperative complication in elderly colorectal cancer patients was 78.7%,68.6%,76.3%,and 75.8%,respectively.ConclusionsFP and CFS have moderate predictive performance for postoperative complications in elderly colorectal cancer patients,and there is no difference in predictive performance between the two.Both CFS and FP can be used for the assessment of preoperative frailty in elderly colorectal cancer patients,but considering clinical applicability,CFS is recommended.