Prognostic value of comorbidities in older patients with cancer: the ELCAPA cohort study.
CIRS-G
cancer
comorbidities
geriatric assessment
Journal
ESMO open
ISSN: 2059-7029
Titre abrégé: ESMO Open
Pays: England
ID NLM: 101690685
Informations de publication
Date de publication:
10 2023
10 2023
Historique:
received:
12
06
2023
revised:
31
08
2023
accepted:
04
09
2023
medline:
30
10
2023
pubmed:
14
10
2023
entrez:
13
10
2023
Statut:
ppublish
Résumé
In older patients, comorbidities competed with cancer for mortality risk. We assessed the prognostic value of comorbidities in older patients with cancer. We analysed all patients >70 years of age with colorectal, breast, prostate, or lung cancer included in the prospective ELCAPA cohort. The Cumulative Illness Rating Scale-Geriatrics (CIRS-G) score was used to assess comorbidities. The primary endpoint was overall survival (OS) at 3, 12, and 36 months. The adjusted difference in the restricted mean survival time (RMST) was used to assess the strength of the relationship between comorbidities and survival. Of the 1551 patients included (median age 82 years; interquartile range 78-86 years), 502 (32%), 575 (38%), 283 (18%), and 191 (12%) had colorectal, breast, prostate, and lung cancer, respectively, and 50% had metastatic disease. Hypertension, kidney failure, and cognitive impairment were the most common comorbidities (67%, 38%, and 29% of the patients, respectively). A CIRS-G score >17, two or more severe comorbidities, more than seven comorbidities, heart failure, and cognitive impairment were independently associated with shorter OS. The greatest effect size was observed for CIRS-G >17 (versus CIRS-G <11): at 36 months, the adjusted differences in the RMST (95% confidence interval) were -6.0 months (-9.3 to -2.6 months) for colorectal cancer, -9.1 months (-13.2 to -4.9 months) for breast cancer, -8.3 months (-12.8 to -3.9 months) for prostate cancer, and -5.5 months (-9.9 to -1.1 months) for lung cancer (P < 0.05 for all). Comorbidities' type, number, and severity were independently associated with shorter OS. A 17-point cut-off over 56 for the total CIRS-G score could be considered in clinical practice.
Sections du résumé
BACKGROUND
In older patients, comorbidities competed with cancer for mortality risk. We assessed the prognostic value of comorbidities in older patients with cancer.
PATIENTS AND METHODS
We analysed all patients >70 years of age with colorectal, breast, prostate, or lung cancer included in the prospective ELCAPA cohort. The Cumulative Illness Rating Scale-Geriatrics (CIRS-G) score was used to assess comorbidities. The primary endpoint was overall survival (OS) at 3, 12, and 36 months. The adjusted difference in the restricted mean survival time (RMST) was used to assess the strength of the relationship between comorbidities and survival.
RESULTS
Of the 1551 patients included (median age 82 years; interquartile range 78-86 years), 502 (32%), 575 (38%), 283 (18%), and 191 (12%) had colorectal, breast, prostate, and lung cancer, respectively, and 50% had metastatic disease. Hypertension, kidney failure, and cognitive impairment were the most common comorbidities (67%, 38%, and 29% of the patients, respectively). A CIRS-G score >17, two or more severe comorbidities, more than seven comorbidities, heart failure, and cognitive impairment were independently associated with shorter OS. The greatest effect size was observed for CIRS-G >17 (versus CIRS-G <11): at 36 months, the adjusted differences in the RMST (95% confidence interval) were -6.0 months (-9.3 to -2.6 months) for colorectal cancer, -9.1 months (-13.2 to -4.9 months) for breast cancer, -8.3 months (-12.8 to -3.9 months) for prostate cancer, and -5.5 months (-9.9 to -1.1 months) for lung cancer (P < 0.05 for all).
CONCLUSIONS
Comorbidities' type, number, and severity were independently associated with shorter OS. A 17-point cut-off over 56 for the total CIRS-G score could be considered in clinical practice.
Identifiants
pubmed: 37832389
pii: S2059-7029(23)01066-9
doi: 10.1016/j.esmoop.2023.101831
pmc: PMC10594025
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
101831Informations de copyright
Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.
Déclaration de conflit d'intérêts
Disclosure The authors have declared no conflicts of interest.
Références
Asia Pac J Clin Oncol. 2016 Mar;12(1):e47-56
pubmed: 24354451
Ann Oncol. 2012 Aug;23(8):2166-2172
pubmed: 22250183
Eur J Cancer. 2000 Mar;36(4):453-71
pubmed: 10717521
J Clin Oncol. 1998 Apr;16(4):1582-7
pubmed: 9552069
Br J Cancer. 2012 Mar 27;106(7):1353-60
pubmed: 22353805
J Chronic Dis. 1987;40(5):373-83
pubmed: 3558716
J Clin Oncol. 2004 Aug 1;22(15):3099-103
pubmed: 15284260
Cancer. 2008 Mar 15;112(6):1354-62
pubmed: 18286532
Ann Epidemiol. 1996 Sep;6(5):399-412
pubmed: 8915471
Cancer. 1996 Mar 1;77(5):834-42
pubmed: 8608472
J Clin Epidemiol. 2012 Sep;65(9):924-33
pubmed: 22739245
CA Cancer J Clin. 2018 Nov;68(6):394-424
pubmed: 30207593
BMC Cancer. 2020 Jan 28;20(1):2
pubmed: 31987032
J Am Geriatr Soc. 2008 Oct;56(10):1926-31
pubmed: 18811613
N Z Med J. 2011 Jul 08;124(1338):76-88
pubmed: 21946965
Diabetologia. 2012 Aug;55(8):2163-72
pubmed: 22526616
BMC Cancer. 2009 Apr 20;9:116
pubmed: 19379520
JAMA. 1963 Sep 21;185:914-9
pubmed: 14044222
Clin Epidemiol. 2013 Nov 01;5(Suppl 1):3-29
pubmed: 24227920
J Geriatr Oncol. 2016 Jul;7(4):249-57
pubmed: 26725537
PLoS One. 2014 Dec 11;9(12):e115060
pubmed: 25503576
J Am Geriatr Soc. 2006 Dec;54(12):1898-904
pubmed: 17198496
CA Cancer J Clin. 2022 Jan;72(1):7-33
pubmed: 35020204
Cancer. 2014 May 1;120(9):1290-314
pubmed: 24343171
Gerontologist. 1969 Autumn;9(3):179-86
pubmed: 5349366
J Am Geriatr Soc. 1995 Feb;43(2):130-7
pubmed: 7836636
Int J Colorectal Dis. 2011 Apr;26(4):483-92
pubmed: 21212966
Ann Oncol. 2012 Mar;23(3):604-610
pubmed: 21586686
J Gerontol A Biol Sci Med Sci. 2015 Sep;70(9):1148-55
pubmed: 25834194
J Clin Oncol. 2018 Aug 1;36(22):2326-2347
pubmed: 29782209
Eur J Cancer. 2021 Nov;157:308-347
pubmed: 34560371
Lancet Oncol. 2014 Jan;15(1):23-34
pubmed: 24314615
Oncologist. 2018 Apr;23(4):433-439
pubmed: 29242282
J Clin Oncol. 2014 Aug 1;32(22):2380-5
pubmed: 24982461
Crit Rev Oncol Hematol. 2007 Mar;61(3):269-76
pubmed: 17207632
JAMA. 2004 May 26;291(20):2441-7
pubmed: 15161894