Introduction

Previous studies have developed risk stratification schemas to assess systemic therapy toxicity. However, it is controversial which geriatric assessment variables should be used to assess the individual risk of severe treatment-associated toxicity in older adult patients.

Materials and methods

Patients aged ≥70 years with advanced non-small cell lung cancer (NSCLC) treated at 24 National Hospital Organization institutions completed a pre-first-line systemic therapy assessment, including patient characteristics, treatment variables, laboratory test values, and geriatric assessment variables. Patients were followed through one cycle of systemic therapy to assess grade 3 (severe) to grade 5 (death) adverse events according to the National Cancer Institute Common Terminology Criteria for Adverse Events, version 4.0.

Results

In total, 348 advanced NSCLC patients with a median age of 76 years (range, 70 to 95 years) joined this prospective study. Severe adverse events ≥grade 3 occurred in 136 patients (39.1%). Predictors of hematologic toxicity were treatment variables, body mass index, body weight loss, and limitation in daily living due to dementia. These predictors provided the predictive model of hematologic toxicity ≥grade 3; 0 point (22.2%), 1 point (33.8%), 2 points (59.6%), ≥3 points (73.3%). Sex, daily living independence level, and lactate dehydrogenase levels were associated with non-hematologic toxicity ≥grade 3 in multivariate analysis. A scoring system using these predictors distinguished the risk levels of non-hematologic toxicity ≥grade 3; 0 point (6.6%), 1 point (12.2%), 2 points (39.0%), 3 points (75.0%).

Discussion

A stratification using individual extracted risk factors may be useful to predict the vulnerability to systemic therapy in older adult NSCLC patients.

中文翻译：

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预测老年晚期非小细胞肺癌患者的全身治疗毒性：日本国立医院组织的一项前瞻性多中心研究

介绍

以前的研究已经制定了风险分层方案来评估全身治疗的毒性。然而，应该使用哪些老年评估变量来评估老年患者严重治疗相关毒性的个体风险存在争议。

材料和方法

在 24 家国家医院组织机构接受治疗的年龄≥70 岁的晚期非小细胞肺癌 (NSCLC) 患者完成了一线前全身治疗评估，包括患者特征、治疗变量、实验室测试值和老年评估变量。根据国家癌症研究所不良事件通用术语标准 4.0 版，对患者进行一个周期的全身治疗，以评估 3 级（严重）至 5 级（死亡）的不良事件。

结果

总共有 348 名中位年龄为 76 岁（范围为 70 至 95 岁）的晚期 NSCLC 患者参加了这项前瞻性研究。136 名患者 (39.1%) 发生了≥3 级的严重不良事件。血液学毒性的预测因素是治疗变量、体重指数、体重减轻和痴呆症导致的日常生活受限。这些预测因子提供了 ≥ 3 级血液学毒性的预测模型；0分（22.2%）、1分（33.8%）、2分（59.6%）、≥3分（73.3%）。在多变量分析中，性别、日常生活独立性水平和乳酸脱氢酶水平与≥3 级的非血液学毒性相关。使用这些预测因子的评分系统区分非血液学毒性≥3 级的风险水平；0分（6.6%）、1分（12.2%）、2分（39.0%）、3分（75.0%）。

讨论

使用个体提取的风险因素进行分层可能有助于预测老年 NSCLC 患者对全身治疗的脆弱性。