预测老年结直肠癌手术患者的功能恢复和生活质量:来自国际GOSAFE研究的真实世界数据

IF 42.1 1区医学 Q1 ONCOLOGY

Journal of Clinical Oncology Pub Date : 2023-12-01 Epub Date: 2023-06-30 DOI:10.1200/JCO.22.02195

Isacco Montroni, Giampaolo Ugolini, Nicole M Saur, Siri Rostoft, Antonino Spinelli, Barbara L Van Leeuwen, Nicola De Liguori Carino, Federico Ghignone, Michael T Jaklitsch, Jakub Kenig, Anna Garutti, Chiara Zingaretti, Flavia Foca, Bernadette Vertogen, Oriana Nanni, Steven D Wexner, Riccardo A Audisio

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Postoperative FR was defined as a combination of Activity of Daily Living ≥5 + Timed Up & Go test <20 seconds + MiniCog >2.Results: Prospective complete data were available for 625/646 consecutive patients (96.9%; 435 colon and 190 rectal cancer), 52.6% men, and median age was 79.0 years (IQR, 74.6-82.9 years). Surgery was minimally invasive in 73% of patients (321/435 colon; 135/190 rectum). At 3-6 months, 68.9%-70.3% patients experienced equal/better QoL (72.8%-72.9% colon, 60.1%-63.9% rectal cancer). At logistic regression analysis, preoperative Flemish Triage Risk Screening Tool ≥2 (3-month odds ratio [OR], 1.68; 95% CI, 1.04 to 2.73; P = .034, 6-month OR, 1.71; 95% CI, 1.06 to 2.75; P = .027) and postoperative complications (3-month OR, 2.03; 95% CI, 1.20 to 3.42; P = .008, 6-month OR, 2.56; 95% CI, 1.15 to 5.68; P = .02) are associated with decreased QoL after colectomy. Eastern Collaborative Oncology Group performance status (ECOG PS) ≥2 is a strong predictor of postoperative QoL decline in the rectal cancer subgroup (OR, 3.81; 95% CI, 1.45 to 9.92; P = .006). FR was reported by 254/323 (78.6%) patients with colon and 94/133 (70.6%) with rectal cancer. Charlson Age Comorbidity Index ≥7 (OR, 2.59; 95% CI, 1.26 to 5.32; P = .009), ECOG ≥2 (OR, 3.12; 95% CI, 1.36 to 7.20; P = .007 colon; OR, 4.61; 95% CI, 1.45 to 14.63; P = .009 rectal surgery), severe complications (OR, 17.33; 95% CI, 7.30 to 40.8; P < .001), fTRST ≥2 (OR, 2.71; 95% CI, 1.40 to 5.25; P = .003), and palliative surgery (OR, 4.11; 95% CI, 1.29 to 13.07; P = .017) are risk factors for not achieving FR.Conclusion: The majority of older patients experience good QoL and stay independent after colorectal cancer surgery. 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引用次数: 0

摘要

目的:GOSAFE研究评估老年结肠癌和直肠癌手术患者未能实现良好生活质量(QoL)和功能恢复(FR)的危险因素。方法:前瞻性纳入70岁及以上接受择期大肠癌手术的患者。术后3/6个月进行衰弱评估并记录预后，包括生活质量(EQ-5D-3L)。术后FR定义为日常生活活动≥5 + Timed Up & Go测试2的组合。结果:625/646例连续患者获得前瞻性完整数据(96.9%;结肠癌435例，直肠癌190例)，男性占52.6%，中位年龄79.0岁(IQR, 74.6-82.9岁)。73%的患者采用微创手术(321/435结肠;135/190直肠)。在3-6个月时，68.9%-70.3%的患者生活质量相同或更好(结肠癌72.8%-72.9%，直肠癌60.1%-63.9%)。经logistic回归分析，术前Flemish Triage Risk Screening Tool≥2(3个月优势比[OR]， 1.68;95% CI, 1.04 ~ 2.73;P = 0.034, 6个月OR为1.71;95% CI, 1.06 ~ 2.75;P = 0.027)和术后并发症(3个月OR, 2.03;95% CI, 1.20 ~ 3.42;P = 0.008, 6个月OR为2.56;95% CI, 1.15 ~ 5.68;P = .02)与结肠切除术后生活质量下降有关。东部肿瘤合作组表现状态(ECOG PS)≥2是直肠癌亚组术后生活质量下降的有力预测因子(OR, 3.81;95% CI, 1.45 ~ 9.92;P = .006)。254/323例(78.6%)结肠癌患者报告FR, 94/133例(70.6%)直肠癌患者报告FR。Charlson年龄合并症指数≥7 (OR, 2.59;95% CI, 1.26 ~ 5.32;P = 0.009)， ecog≥2(或3.12;95% CI, 1.36 ~ 7.20;P = .007冒号;或者,4.61;95% CI, 1.45 ~ 14.63;P = 0.009直肠手术)，严重并发症(OR, 17.33;95% CI, 7.30 ~ 40.8;P < 0.001)， fTRST≥2 (OR, 2.71;95% CI, 1.40 ~ 5.25;P = 0.003)，姑息性手术(OR, 4.11;95% CI, 1.29 ~ 13.07;P = 0.017)是结直肠癌术后老年患者生活质量较好、生活自理的危险因素。未能达到这些基本结果的预测因素现在被定义为指导患者和家属的术前咨询。

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Predicting Functional Recovery and Quality of Life in Older Patients Undergoing Colorectal Cancer Surgery: Real-World Data From the International GOSAFE Study.

Purpose: The GOSAFE study evaluates risk factors for failing to achieve good quality of life (QoL) and functional recovery (FR) in older patients undergoing surgery for colon and rectal cancer.

Methods: Patients age 70 years and older undergoing major elective colorectal surgery were prospectively enrolled. Frailty assessment was performed and outcomes, including QoL (EQ-5D-3L) recorded (3/6 months postoperatively). Postoperative FR was defined as a combination of Activity of Daily Living ≥5 + Timed Up & Go test <20 seconds + MiniCog >2.

Results: Prospective complete data were available for 625/646 consecutive patients (96.9%; 435 colon and 190 rectal cancer), 52.6% men, and median age was 79.0 years (IQR, 74.6-82.9 years). Surgery was minimally invasive in 73% of patients (321/435 colon; 135/190 rectum). At 3-6 months, 68.9%-70.3% patients experienced equal/better QoL (72.8%-72.9% colon, 60.1%-63.9% rectal cancer). At logistic regression analysis, preoperative Flemish Triage Risk Screening Tool ≥2 (3-month odds ratio [OR], 1.68; 95% CI, 1.04 to 2.73; P = .034, 6-month OR, 1.71; 95% CI, 1.06 to 2.75; P = .027) and postoperative complications (3-month OR, 2.03; 95% CI, 1.20 to 3.42; P = .008, 6-month OR, 2.56; 95% CI, 1.15 to 5.68; P = .02) are associated with decreased QoL after colectomy. Eastern Collaborative Oncology Group performance status (ECOG PS) ≥2 is a strong predictor of postoperative QoL decline in the rectal cancer subgroup (OR, 3.81; 95% CI, 1.45 to 9.92; P = .006). FR was reported by 254/323 (78.6%) patients with colon and 94/133 (70.6%) with rectal cancer. Charlson Age Comorbidity Index ≥7 (OR, 2.59; 95% CI, 1.26 to 5.32; P = .009), ECOG ≥2 (OR, 3.12; 95% CI, 1.36 to 7.20; P = .007 colon; OR, 4.61; 95% CI, 1.45 to 14.63; P = .009 rectal surgery), severe complications (OR, 17.33; 95% CI, 7.30 to 40.8; P < .001), fTRST ≥2 (OR, 2.71; 95% CI, 1.40 to 5.25; P = .003), and palliative surgery (OR, 4.11; 95% CI, 1.29 to 13.07; P = .017) are risk factors for not achieving FR.

Conclusion: The majority of older patients experience good QoL and stay independent after colorectal cancer surgery. Predictors for failing to achieve these essential outcomes are now defined to guide patients' and families' preoperative counseling.

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来源期刊

Journal of Clinical Oncology 医学-肿瘤学

CiteScore

41.20

自引率

2.20%

发文量

8215

审稿时长

2 months

期刊介绍： The Journal of Clinical Oncology serves its readers as the single most credible, authoritative resource for disseminating significant clinical oncology research. In print and in electronic format, JCO strives to publish the highest quality articles dedicated to clinical research. Original Reports remain the focus of JCO, but this scientific communication is enhanced by appropriately selected Editorials, Commentaries, Reviews, and other work that relate to the care of patients with cancer.