Background

There is controversy regarding treatment of nonmelanoma skin cancer (NMSC) in very elderly individuals, with some suggesting that this population may not live long enough to benefit from invasive treatments. Tools to assess limited life expectancy (LLE) exist, but performance in the population of very elderly individuals with NMSC has not been well defined.

Objective

Define comorbidity scores associated with LLE in very elderly individuals presenting for management of NMSC.

Methods

A retrospective review of 488 patients age 85 or older presenting for NMSC management between July 1999 through December 2014 was performed. Comorbidities were scored by using the Adult Comorbidity Evaluation-27 (ACE-27) and age-adjusted Charlson comorbidity index (ACCI). Dates of death, follow-up, and overall survival were determined.

Results

ACE-27 and ACCI scores were associated with overall survival; at scores of 3 and 7+, respectively, both were associated with less than 50% survival at 4 years. Patients who underwent Mohs micrographic surgery survived a median of 20 months longer than patients who did not.

Limitations

Retrospective study design and referral bias.

Conclusions

ACE-27 and ACCI scores predicted LLE. The cohort presenting for Mohs micrographic surgery had improved survival, despite similar intercohort comorbidity. This suggests that additional factors contributed to survival and that age and comorbidities alone are inadequate for making NMSC treatment decisions in very elderly individuals.

中文翻译：

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非黑色素瘤皮肤癌高龄患者预期寿命有限的合并症评分

背景

关于非常年长个体的非黑色素瘤皮肤癌 (NMSC) 的治疗存在争议，一些人认为这一人群的寿命可能不足以从侵入性治疗中受益。存在评估有限预期寿命 (LLE) 的工具，但尚未明确定义患有 NMSC 的高龄人群的表现。

客观的

在接受 NMSC 管理的高龄个体中定义与 LLE 相关的合并症评分。

方法

对 1999 年 7 月至 2014 年 12 月期间接受 NMSC 管理的 488 名年龄在 85 岁或以上的患者进行了回顾性研究。通过使用成人合并症评估 27 (ACE-27) 和年龄调整的查尔森合并症指数 (ACCI) 对合并症进行评分。确定死亡日期、随访日期和总生存期。

结果

ACE-27 和 ACCI 评分与总生存期相关；分数分别为 3 和 7+，两者的 4 年生存率均低于 50%。接受莫氏显微手术的患者比没有接受的患者平均多活了 20 个月。

限制

回顾性研究设计和转诊偏倚。

结论

ACE-27 和 ACCI 分数可预测 LLE。尽管存在类似的队列间合并症，但进行 Mohs 显微手术的队列提高了生存率。这表明其他因素有助于生存，仅年龄和合并症不足以在非常高龄的个体中做出 NMSC 治疗决策。