Background: Comprehensive Geriatric Assessment (CGA) is essential for evaluating older cancer patients, but significant gaps persist in both research and clinical practice. This study aimed (I) to identify the CGA elements that most influence anti-cancer treatment decisions in older patients and (II) to explore the predictive value of CGA components for mortality.Methods: This observational study included older patients with newly diagnosed, histologically confirmed solid or hematological cancers, recruited consecutively from 2003 to 2023. Participants were followed for four years. The data collected included CGA measures of functional (Activities of Daily Living-ADL), cognitive (Mini-Mental State Examination-MMSE), and emotional (Geriatric Depression Scale-GDS) domains. Patients were categorized into frail, vulnerable, or fit groups based on Balducci’s criteria. Statistical analyses included decision tree modeling and Cox regression to identify predictors of mortality.Results: A total of 7022 patients (3222 females) were included, with a mean age of 78.3 ± 12.9 years. The key CGA factors influencing treatment decisions were ADL (first step), cohabitation status (second step), and age (last step). After four years, 21.9% patients had died. Higher GDS scores (OR 1.04, 95% CI 1.01–1.07,p= 0.04) were independently associated with survival in men and living with family members (OR 1.67, 95% CI 1.35–2.07,p< 0.001) in women. Younger patients (<77 years) showed both MMSE and GDS as significant risk factors for mortality.Conclusions: Functional capacity, cohabitation status, and GDS scores are crucial for guiding treatment decisions and predicting mortality in older cancer patients, emphasizing the need for a multidimensional geriatric assessment.
背景：老年综合评估（CGA）对老年癌症患者的评估至关重要，但当前研究与临床实践仍存在显著差距。本研究旨在（I）识别对老年患者抗癌治疗决策影响最大的CGA要素，以及（II）探讨CGA各组成部分对死亡率的预测价值。 方法：本观察性研究连续纳入2003年至2023年新诊断、经组织学确诊的实体瘤或血液系统恶性肿瘤老年患者，并进行为期四年的随访。收集的数据包括CGA的功能（日常生活活动能力-ADL）、认知（简易精神状态检查-MMSE）和情绪（老年抑郁量表-GDS）领域评估指标。根据Balducci标准将患者分为衰弱、易损或健康三组。采用决策树模型和Cox回归分析确定死亡率的预测因素。 结果：共纳入7022例患者（女性3222例），平均年龄78.3±12.9岁。影响治疗决策的关键CGA因素依次为ADL（第一步）、同居状况（第二步）和年龄（最后一步）。四年随访期间，21.9%的患者死亡。较高GDS评分（OR 1.04，95% CI 1.01–1.07，p=0.04）与男性生存独立相关，而与家庭成员同住（OR 1.67，95% CI 1.35–2.07，p<0.001）与女性生存相关。较年轻患者（<77岁）中，MMSE和GDS均为死亡率的显著风险因素。 结论：功能状态、同居状况和GDS评分对指导老年癌症患者的治疗决策及预测死亡率至关重要，这强调了多维老年评估的必要性。
肿瘤(癌症)患者之家