Journal of geriatric oncology · 2025
Development of a new model for prediction of relevant treatment related adverse events in older individuals with gastrointestinal cancers.
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Shenoy Vallish, Kannan Sadhana, Noronha Vanita, Prabhash Kumar, Ostwal Vikas, Bhargava Prabhat, Pillai Anupa, Shamseeya K, Shetake Ankush, Dhekale Ratan, Chitre Ankita, Gota Vikram, Mahajan Sarika, Daptardar Anuradha, Sonkusare Lekhika, Deodhar Jayita, Ansari Nabila, Vagal Manjusha, Mahajan Purabi, Nookala Manjunath, Banavali Shripad D, Ramaswamy Anant
Аннотация
INTRODUCTION: Limited tools exist to specifically predict the risk of chemotherapy toxicity and related events in older individuals with gastrointestinal (GI) cancers.
MATERIALS AND METHODS: We evaluated patients aged ≥60 years with GI cancers who underwent a comprehensive geriatric assessment comprising demographic, cancer variables, and geriatric domains (function, comorbidities, nutritional status, medications, cognition, psychological status, and social support). A Cancer and Aging Research Group (CARG) score was calculated in all patients. The occurrence of grade 3 to 5 adverse events, emergent hospitalizations, and sudden death without identifiable adverse events were defined as treatment related adverse events (TRAE) to form the new predictive model. Based on initial univariate analysis of factors predicting for TRAE and then multivariate analysis, a nomogram was developed to predict the probability TRAEs. The total score derived from the nomogram was categorized into low, moderate, and high-risk groups based on a recursive partitioning algorithm.
RESULTS: In total, 701 patients with a median age of 67 years (range, 60 to 88 years) with predominantly stage IV cancers (58 %) were analysed. The distribution of GI cancers was gastric and esophageal cancers (n = 349, 50 %), hepatobiliary and pancreatic cancers (n = 241, 34 %), and colorectal cancers (n = 84, 12 %). TRAE occurred in 53 % of the patients. A predictive model for TRAE was developed using the Mobility-Tiredness (Mob-T) Scale, hearing, cancer stage, site of primary, and chemotherapy dosing (standard or reduced). A predictive score in which the median risk score was 22 (range, 0 to 40) and risk stratification identified older adults at low risk (0 to 13 points; 17 %), intermediate risk (14 to 21 points; 40 %), or high risk (>22 points; 71 %) of chemotherapy toxicity (P < 0.001). The new model outperformed the CARG score based on ROC analysis (0.75 vs 0.59, p < 0.001).
DISCUSSION: A new and simpler risk score predicts for chemotherapy related adverse events in older patients with GI cancers and seems to be more accurate than the CARG score. The score requires validation in prospective studies.
MATERIALS AND METHODS: We evaluated patients aged ≥60 years with GI cancers who underwent a comprehensive geriatric assessment comprising demographic, cancer variables, and geriatric domains (function, comorbidities, nutritional status, medications, cognition, psychological status, and social support). A Cancer and Aging Research Group (CARG) score was calculated in all patients. The occurrence of grade 3 to 5 adverse events, emergent hospitalizations, and sudden death without identifiable adverse events were defined as treatment related adverse events (TRAE) to form the new predictive model. Based on initial univariate analysis of factors predicting for TRAE and then multivariate analysis, a nomogram was developed to predict the probability TRAEs. The total score derived from the nomogram was categorized into low, moderate, and high-risk groups based on a recursive partitioning algorithm.
RESULTS: In total, 701 patients with a median age of 67 years (range, 60 to 88 years) with predominantly stage IV cancers (58 %) were analysed. The distribution of GI cancers was gastric and esophageal cancers (n = 349, 50 %), hepatobiliary and pancreatic cancers (n = 241, 34 %), and colorectal cancers (n = 84, 12 %). TRAE occurred in 53 % of the patients. A predictive model for TRAE was developed using the Mobility-Tiredness (Mob-T) Scale, hearing, cancer stage, site of primary, and chemotherapy dosing (standard or reduced). A predictive score in which the median risk score was 22 (range, 0 to 40) and risk stratification identified older adults at low risk (0 to 13 points; 17 %), intermediate risk (14 to 21 points; 40 %), or high risk (>22 points; 71 %) of chemotherapy toxicity (P < 0.001). The new model outperformed the CARG score based on ROC analysis (0.75 vs 0.59, p < 0.001).
DISCUSSION: A new and simpler risk score predicts for chemotherapy related adverse events in older patients with GI cancers and seems to be more accurate than the CARG score. The score requires validation in prospective studies.