Prognostic value of baseline functional status measures and geriatric screening in vulnerable older patients with metastatic colorectal cancer receiving palliative chemotherapy – The randomized NORDIC9-study
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Prognostic value of baseline functional status measures and geriatric screening in vulnerable older patients with metastatic colorectal cancer receiving palliative chemotherapy – The randomized NORDIC9-study. / Liposits, Gabor; Ryg, Jesper; Skuladottir, Halla; Winther, Stine B.; Möller, Sören; Hofsli, Eva; Shah, Carl-Henrik; Poulsen, Laurids Østergaard; Berglund, Åke; Qvortrup, Camilla; Osterlund, Pia; Glimelius, Bengt; Sorbye, Halfdan; Pfeiffer, Per.
I: Journal of Geriatric Oncology, Bind 14, Nr. 1, 101408, 2023.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Prognostic value of baseline functional status measures and geriatric screening in vulnerable older patients with metastatic colorectal cancer receiving palliative chemotherapy – The randomized NORDIC9-study
AU - Liposits, Gabor
AU - Ryg, Jesper
AU - Skuladottir, Halla
AU - Winther, Stine B.
AU - Möller, Sören
AU - Hofsli, Eva
AU - Shah, Carl-Henrik
AU - Poulsen, Laurids Østergaard
AU - Berglund, Åke
AU - Qvortrup, Camilla
AU - Osterlund, Pia
AU - Glimelius, Bengt
AU - Sorbye, Halfdan
AU - Pfeiffer, Per
N1 - Publisher Copyright: © 2022 The Authors
PY - 2023
Y1 - 2023
N2 - Introduction: Appropriate patient selection based on functional status is crucial when considering older adults for palliative chemotherapy. This pre-planned analysis of the randomized NORDIC9-study explored the prognostic value of four functional status measures regarding progression-free survival (PFS) and overall survival (OS) in vulnerable older patients with metastatic colorectal cancer (mCRC) receiving first-line palliative chemotherapy. Materials and methods: Patients ≥70 years of age with mCRC not candidates for standard full-dose combination chemotherapy were randomized to receive full-dose S1 or reduced-dose S1 + oxaliplatin. At baseline, functional status was assessed using ECOG performance status (ECOG PS), frailty phenotype, Geriatric 8 (G8), and Vulnerable Elderly Survey-13 (VES-13). Multivariable regression models were applied and C-statistics were estimated. Results: In total, 160 patients with a median age of 78 years (IQR: 76–81) were included. While in univariate analyses, ECOG PS, frailty phenotype, and VES-13 were statistically significantly associated with differences in OS between subgroups, G8 was not (HR = 1.55, 95%CI: 0.99–2.41, p = 0.050). In multivariable analyses adjusted for age, sex, body mass index, and treatment allocation, we found significant differences between subgroups for all applied tools and with C-statistics in the moderate range for ECOG PS and VES-13. Concerning PFS, statistically significant differences were observed between subgroups of ECOG PS, G8, and VES-13 both in uni- and multivariable analyses, but not for frailty phenotype. Discussion: In this Nordic cohort of vulnerable older patients with mCRC, baseline ECOG PS, frailty phenotype, G8, and VES-13 showed prognostic value regarding overall survival, and moderate predictive value of models based on ECOG PS and VES-13 was demonstrated.
AB - Introduction: Appropriate patient selection based on functional status is crucial when considering older adults for palliative chemotherapy. This pre-planned analysis of the randomized NORDIC9-study explored the prognostic value of four functional status measures regarding progression-free survival (PFS) and overall survival (OS) in vulnerable older patients with metastatic colorectal cancer (mCRC) receiving first-line palliative chemotherapy. Materials and methods: Patients ≥70 years of age with mCRC not candidates for standard full-dose combination chemotherapy were randomized to receive full-dose S1 or reduced-dose S1 + oxaliplatin. At baseline, functional status was assessed using ECOG performance status (ECOG PS), frailty phenotype, Geriatric 8 (G8), and Vulnerable Elderly Survey-13 (VES-13). Multivariable regression models were applied and C-statistics were estimated. Results: In total, 160 patients with a median age of 78 years (IQR: 76–81) were included. While in univariate analyses, ECOG PS, frailty phenotype, and VES-13 were statistically significantly associated with differences in OS between subgroups, G8 was not (HR = 1.55, 95%CI: 0.99–2.41, p = 0.050). In multivariable analyses adjusted for age, sex, body mass index, and treatment allocation, we found significant differences between subgroups for all applied tools and with C-statistics in the moderate range for ECOG PS and VES-13. Concerning PFS, statistically significant differences were observed between subgroups of ECOG PS, G8, and VES-13 both in uni- and multivariable analyses, but not for frailty phenotype. Discussion: In this Nordic cohort of vulnerable older patients with mCRC, baseline ECOG PS, frailty phenotype, G8, and VES-13 showed prognostic value regarding overall survival, and moderate predictive value of models based on ECOG PS and VES-13 was demonstrated.
KW - Chemotherapy
KW - Colorectal cancer
KW - ECOG performance status
KW - Frailty phenotype
KW - Functional status
KW - Geriatric 8
KW - Older adults
KW - Prognosis
KW - Survival
KW - Vulnerable Elderly Survey-13
U2 - 10.1016/j.jgo.2022.11.007
DO - 10.1016/j.jgo.2022.11.007
M3 - Journal article
C2 - 36494261
AN - SCOPUS:85143968308
VL - 14
JO - Journal of Geriatric Oncology
JF - Journal of Geriatric Oncology
SN - 1879-4068
IS - 1
M1 - 101408
ER -
ID: 362384812