The treatment choice for an older patient with diffuse large B-cell lymphoma (DLBCL) depends on many other factors in addition to age, which alone does not reflect the complexity of the aging process. Functional features and comorbidity incidence differ not only between younger and older patients but also among older patients themselves. The comprehensive geriatric assessment (CGA) quickly evaluates fitness status by investigating the patient’s different functional areas, degree of autonomy, and presence of comorbidities. Various tools are available to evaluate frailty; which assessment tool to use should be based on the clinical aim. The simplified geriatric assessment (sGA) from the elderly project by the Fondazione Italiana Linfomi, prospectively tested on the largest number of patients, categorizes patients as fit, unfit, or frail, with a decreasing rate of overall survival. The elderly prognostic index (EPI), which combines sGA and IPI scores and hemoglobin level, is the first prognostic score for older patients, with three risk groups for survival. Future GAs should consider new parameters, including sarcopenia, which appears to be inversely related to survival. New tools based on prospective studies can help physicians choose the best treatment in light of the individual patient’s characteristics.
对于老年弥漫性大B细胞淋巴瘤患者的治疗选择，除年龄外还需综合考虑多种因素，因为年龄本身并不能反映衰老过程的复杂性。功能特征与合并症发生率不仅在年轻患者与老年患者之间存在差异，在老年患者群体内部也各不相同。综合老年评估通过考察患者不同功能领域、自主能力程度及合并症存在情况，可快速评估其体能状态。目前存在多种评估衰弱状态的工具，具体工具的选择应基于临床目标。意大利淋巴瘤基金会老年项目开发的简化老年评估已在最大规模患者群体中完成前瞻性验证，该工具将患者分为体能良好、体能欠佳和衰弱三类，其总体生存率呈递减趋势。结合简化老年评估、国际预后指数评分及血红蛋白水平构建的老年预后指数，是首个针对老年患者的预后评分系统，可将生存风险划分为三个等级。未来的老年评估应考虑纳入新的参数，包括与生存率呈负相关的肌肉减少症。基于前瞻性研究开发的新工具将有助于临床医生根据患者个体特征选择最佳治疗方案。
The Role of Geriatric Assessment in the Management of Diffuse Large B-Cell Lymphoma
肿瘤(癌症)患者之家