Ki Hyang Kim1, Jae Jin Lee2, Jongphil Kim3, Jun-Min Zhou3, Fabio Gomes4, Marina Sehovic5, Martine Extermann6. 1. Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea; Senior Adult Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA. 2. Senior Adult Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA; Division of Medical Oncology and Hematology, Department of Internal Medicine, Yonsei Noble Hospital, Seoul, South Korea. 3. Department of Biostatistics and Bioinformatics, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA. 4. Senior Adult Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA; Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, United Kingdom. 5. Senior Adult Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA. 6. Senior Adult Oncology Program, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA. Electronic address: martine.extermann@moffitt.org.
Abstract
BACKGROUND: Studies of older patients with colorectal cancer(CRC) have found inconsistent results about the correlation of various comorbidities with overall survival(OS) and treatment tolerance. To refine our understanding, we evaluated this correlation using the Cumulative Illness Rating Scale-Geriatric(CIRS-G) and heat maps to identify subgroups with the highest impact. METHODS: We retrospectively reviewed 153 patients aged 65 years and older with stage IV CRC undergoing chemotherapy. We calculated CIRS-G scores, and a Total Risk Score(TRS) derived from a previous heat map study. The association between CIRS-G scores/TRS and OS, unplanned hospitalizations, and chemotoxicity was examined by the Cox proportional hazards model. RESULTS: Median age was 71 years. Median MAX2 score of chemotherapies was 0.134(0.025-0.231). The most common comorbidities were vascular(79.8%), eye/ear/nose/throat(68%), and respiratory disease(52.4%). Median OS was 25.1 months(95% confidence interval: 21.2-27.6). In univariate analysis, ECOG PS ≥ 2(HR 1.86(1.1-3.17), p = 0.019), poorly differentiated histology(HR 2.03(1.27-3.25), p = 0.003), primary site(rectum vs colon)(HR 0.58 (0.34-0.98), p = 0.04), age at diagnosis(HR per 5y 1.20 (1.04-1.39), p = 0.012), and number of CIRS-G grade 4 comorbidities(HR 1.86 (1.1-3.17), p = 0.019) were associated with OS. In multivariate analysis, the number of CIRS-G grade 4 comorbidities lost significance, although it retained it in the subgroup of patients with colon cancer. Conversely, the TRS was associated with OS in patients with rectal cancer. No association of comorbidity with unplanned hospitalization or chemotoxicity was observed. CONCLUSIONS: In older adults with metastatic CRC, the number of CIRS-G grade 4 comorbidities was associated with worse OS but no specific CIRS-G category was independently associated with OS, unplanned hospitalization, or toxicities.
BACKGROUND: Studies of older patients with colorectal cancer(CRC) have found inconsistent results about the correlation of various comorbidities with overall survival(OS) and treatment tolerance. To refine our understanding, we evaluated this correlation using the Cumulative Illness Rating Scale-Geriatric(CIRS-G) and heat maps to identify subgroups with the highest impact. METHODS: We retrospectively reviewed 153 patients aged 65 years and older with stage IV CRC undergoing chemotherapy. We calculated CIRS-G scores, and a Total Risk Score(TRS) derived from a previous heat map study. The association between CIRS-G scores/TRS and OS, unplanned hospitalizations, and chemotoxicity was examined by the Cox proportional hazards model. RESULTS: Median age was 71 years. Median MAX2 score of chemotherapies was 0.134(0.025-0.231). The most common comorbidities were vascular(79.8%), eye/ear/nose/throat(68%), and respiratory disease(52.4%). Median OS was 25.1 months(95% confidence interval: 21.2-27.6). In univariate analysis, ECOG PS ≥ 2(HR 1.86(1.1-3.17), p = 0.019), poorly differentiated histology(HR 2.03(1.27-3.25), p = 0.003), primary site(rectum vs colon)(HR 0.58 (0.34-0.98), p = 0.04), age at diagnosis(HR per 5y 1.20 (1.04-1.39), p = 0.012), and number of CIRS-G grade 4 comorbidities(HR 1.86 (1.1-3.17), p = 0.019) were associated with OS. In multivariate analysis, the number of CIRS-G grade 4 comorbidities lost significance, although it retained it in the subgroup of patients with colon cancer. Conversely, the TRS was associated with OS in patients with rectal cancer. No association of comorbidity with unplanned hospitalization or chemotoxicity was observed. CONCLUSIONS: In older adults with metastatic CRC, the number of CIRS-G grade 4 comorbidities was associated with worse OS but no specific CIRS-G category was independently associated with OS, unplanned hospitalization, or toxicities.
Authors: Bjørn H Grønberg; Stein Sundstrøm; Stein Kaasa; Roy M Bremnes; Oystein Fløtten; Tore Amundsen; Harald H Hjelde; Christian von Plessen; Marit Jordhøy Journal: Eur J Cancer Date: 2010-05-12 Impact factor: 9.162
Authors: M D Miller; C F Paradis; P R Houck; S Mazumdar; J A Stack; A H Rifai; B Mulsant; C F Reynolds Journal: Psychiatry Res Date: 1992-03 Impact factor: 3.222
Authors: Mohamed L Sorror; Michael B Maris; Rainer Storb; Frederic Baron; Brenda M Sandmaier; David G Maloney; Barry Storer Journal: Blood Date: 2005-06-30 Impact factor: 22.113
Authors: Martine Extermann; Julie Meyer; Margaret McGinnis; Theresa T Crocker; Mary Beth Corcoran; Jerry Yoder; William E Haley; Hongbin Chen; David Boulware; Lodovico Balducci Journal: Crit Rev Oncol Hematol Date: 2004-01 Impact factor: 6.312
Authors: M Extermann; H Chen; A B Cantor; M B Corcoran; J Meyer; E Grendys; D Cavanaugh; S Antonek; A Camarata; W E Haley; L Balducci Journal: Eur J Cancer Date: 2002-07 Impact factor: 9.162
Authors: Heidi D Klepin; Can-Lan Sun; David D Smith; Rawad Elias; Kelly M Trevino; Ashley Leak Bryant; Daneng Li; Christian Nelson; William P Tew; Supriya G Mohile; Ajeet Gajra; Cynthia Owusu; Cary Gross; Stuart M Lichtman; Vani V Katheria; Hyman B Muss; Andrew E Chapman; Harvey Jay Cohen; Arti Hurria; William Dale Journal: JCO Oncol Pract Date: 2021-04-21