简化老年综合评估在老年膀胱癌患者保留膀胱的三联治疗中应用价值

The value of applying simplified Comprehensive Geriatric Assessment to elderly patients with bladder cancer treated with bladder-sparing trimodality treatment

目的评估简化老年综合评估(CGA)分级在老年膀胱癌患者保留膀胱的三联治疗中的应用价值.方法纳入2021年1月-2023年1月湘潭市中心医院放疗科收治的65岁及以上的老年膀胱癌患者为研究对象,根据CGA标准将患者分为适合组、不适合组和虚弱组,分别接受不同治疗方案.结果32例患者中男性28例,女性4例,中位年龄75岁.适合组14例(43.75%)接受顺铂和/或吉西他滨同步放化疗,不适合组10例(31.25%)接受卡培他滨同步放化疗,虚弱组8例(25.00%)接受放疗联合支持治疗.三组患者最常见的不良反应为1-2级.所有患者均完成治疗,其中由于毒副反应导致的放疗完成总时间延长仅2例(6.25%).三组患者的客观缓解率分别为78.57%、60.00%和37.50%;疾病控制率分别为92.86%、80.00%和75.00%;临床完全缓解率分别为50.00%、40.00%和12.50%.结论基于CGA的分级系统选择合适的治疗方案,可以降低治疗毒性,提高患者治疗耐受性.老年膀胱癌患者保留膀胱的三联治疗中进行CGA评估具有临床可行性.

Objective To explore the application value of simplified Comprehensive Geriatric Assessment(CGA)grading in trimodality treatmentfor elderly bladder cancer patients.Methods Elderly bladder cancer patients aged 65 years and above admitted to the radiotherapy department of Xiangtan Central Hospital from January 2021 to January 2023 were included as study subjects.According to the CGA criteria,32 patients were divided into the fit group,the unfit group,and the frail group,and they were respectively treated with different treatment.Results The patients included 28 males and 4 females,with a median age of 75 years.14 patients(43.75%)in the fit group received radiotherapy plus gemcitabine and/or cisplatin,10 patients(31.25%)in the unfit group received radiotherapy plus capecitabine,and 8 patients(25.00%)in the frail group received radiotherapy plussupportive treatment.The most common adverse events(AEs)were grade 1-2.All enrolled patients successfully completed the treatment on time except 2 cases(6.25%)due to toxicity.The overall response rate of the three groups were 78.57%,60.00%and 37.50%;the disease control rate were 92.86%,80.00%and 75.00%;and the clinical complete response were 50.00%,40.00%and 12.50%,respectively.Conclusions The selection of appropriate treatment based on the grading system of CGA can reduce the toxicity of treatment and improve patient tolerance to the treatment.It is clinically feasible to perform CGA assessment in the treatment of elderly bladder cancer patients treated with bladder-sparing trimodality treatment.