Multiple myeloma (MM) is a cancer of older adults and those who are more frail are at high risk of poor outcomes. Current tools for identifying and categorizing frail patients are often static and measured only at the time of diagnosis. The concept of dynamic frailty (i.e. frailty changing over time) is largely unexplored in MM. In our study, adults with newly-diagnosed MM who received novel drugs between the years 2007–2014 were identified in the Surveillance, Epidemiology, and End Results (SEER)-Medicare linked databases. Using a previously published cumulative deficit approach, a frailty index score was calculated at diagnosis and each landmark interval (1-yr, 2-yr, 3-yr post diagnosis). The association of frailty with overall survival (OS) both at baseline and at each landmark interval as well as factors associated with worsening frailty status over time were evaluated. Overall, 4617 patients were included. At baseline, 39% of the patients were categorized as moderately frail or severely frail. Among those who had 3 years of follow-up, frailty categorization changed post diagnosis in 93% of the cohort (78% improved and 72% deteriorated at least at one time point during the follow up period). In a landmark analysis, the predictive ability of frailty at the time of diagnosis decreased over time for OS (Harrell’s C Statistic 0.65 at diagnosis, 0.63 at 1-yr, 0.62 at 2-yr, and 0.60 at 3-yr) and was inferior compared to current frailty status at each landmark interval. Our study is one of the first to demonstrate the dynamic nature of frailty among older adults with MM. Frailty may improve or deteriorate over time. Current frailty status is a better predictor of outcomes than frailty status at time of diagnosis, indicating the need for re-measurement in this high-risk patient population.
多发性骨髓瘤（MM）是一种老年癌症，体质较衰弱的患者预后不良的风险较高。目前识别和分类衰弱患者的工具通常是静态的，仅在诊断时进行评估。动态衰弱（即衰弱状态随时间变化）的概念在MM领域中很大程度上尚未被探索。本研究通过监测、流行病学和最终结果（SEER）-医疗保险关联数据库，确定了2007年至2014年间接受新型药物治疗的新诊断MM成年患者。采用先前发表的累积缺陷法，在诊断时及各个关键时间点（诊断后1年、2年、3年）计算衰弱指数评分。评估了基线及各个关键时间点衰弱与总生存期（OS）的关联，以及随时间推移衰弱状态恶化的相关因素。共纳入4617例患者。基线时，39%的患者被归类为中度或重度衰弱。在有3年随访数据的患者中，93%的队列在诊断后衰弱分类发生变化（78%的患者出现改善，72%的患者在随访期间至少一个时间点出现恶化）。在关键时间点分析中，诊断时的衰弱状态对OS的预测能力随时间推移而下降（Harrell’s C统计量诊断时为0.65，1年时为0.63，2年时为0.62，3年时为0.60），且在各关键时间点均逊于当前的衰弱状态。本研究首次揭示了MM老年患者衰弱状态的动态变化特征。衰弱可能随时间改善或恶化。当前的衰弱状态比诊断时的衰弱状态更能预测患者预后，这表明有必要对这一高危患者群体进行衰弱状态的重复评估。
肿瘤(癌症)患者之家