Prognostic value of multidimensional geriatric assessment (MGA) on survival of a prospective cohort of 880 elderly cancer patients (ECP).

Abstract

9065 Background: Estimated tumor-independent life expectancy is a key element for treatment choices in ECP. MGA allows to subdivide them into three categories of Fit, Vulnerable and Frail pts. Whether MGA is able to predict survival independently from tumor type, stage, and treatment is still an open question. Methods: All consecutive pts ≥70 years admitted to our Geriatric Oncology Program underwent MGA (Basso CROH 2009) and were prospectively followed. All-cause survival was compared according to their condition of fitness, vulnerability or frailty. Type of tumor, disease status at first visit (neoadjuvant/adjuvant vs advanced), administration of any treatment (cytotoxic/endocrine/targeted therapy) were assessed. Kaplan-Meier survival method was used with multivariate (Cox) analysis. Results: From 09-2003 to 10-2010, 880 ECP were enrolled, median 77 yrs (range 70-96), 28% males, with breast (54.5%), colorectal (14.1%), lung (8.2%) or other sites (23.2%) of cancer. Seventy-one percent were seen for neoadjuvant/adjuvant treatment; 79.8% were prescribed some oncological treatment. After a median follow-up of 26 mo (1-77), 334 have died (38%). Status at MGA predicted overall survival (p<0.001). Significance was maintained in the subgroups with adjuvant/neoadjuvant vs advanced disease, treated vs untreated pts, and in pts with breast cancer or other sites, but was lost when only colon or lung cancer were considered (Table). At multivariate analysis, Fitness maintained a strong impact on survival compared to Frailty (HR=0.41, CI:0.31–0.54) as well as Vulnerability vs Frailty (HR= 0.59, CI: 0.45 – 0.77). Conclusions: MGA predicts significantly different survival probability in our large cohort of ECP, independently of stage and treatment. Lack of significance in lung or colorectal cancer may be due to lower patient numbers. Survival (%) at 24 mo (univariate log rank test). Fit 338 pts Vulnerable 288 pts Frail 254 pts P value Overall 83 70 60 <0.001 Disease status Adjuvant/neoadjuvant 93 86 79 <0.001 Advanced 52 33 37 0.009 Disease site Breast 94 90 78 <0.001 Colorectal 75 56 51 0.185 Lung 33 17 17 0.241 Other 68 45 41 0.001 Oncological treatment Yes 83 72 65 <0.001 None 87 74 51 <0.001