Abstract
Simple SummaryDecisions on cancer treatment for older patients take into account not only comorbidities but also physical and cognitive resources. Comprehensive geriatric assessment (CGA) in older patients assesses geriatric frailties but does not include standardized biological tests. The B12/CRP index (BCI) was first intended as a prognosis tool to predict 90-day mortality after advanced cancer diagnosis. This study shows the prognostic link between BCI value and overall cancer survival time in older people, and the association between BCI value and geriatric frailty before cancer treatment in this population.Background: While comprehensive geriatric assessment (CGA) in older patients treated for cancer assesses several related domains, it does not include standardized biological tests. The present study aimed to: (1) assess the prognosis value of the B12/CRP index (BCI) in a population of systemically treatable older patients with cancer and (2) analyze the association between BCI value and pre-existing geriatric frailty. Method: We conducted a retrospective observational study between January 2016 and June 2020 at Marseille University Hospital. All consecutive cancer patients aged 70 years and over before initiating systemic therapy were included. Results: Of the 863 patients included, 60.5% were men and 42.5% had metastatic stage cancer. Mean age was 81 years. The low-BCI group (≤10,000) had a significantly longer survival time than the mid-BCI (10,000 < BCI ≤ 40,000) and high-BCI (BCI > 40,000) groups (HR = 0.327, CI95% [0.26–0.42], p-value = 0.0001). Mid- and high-BCI (BCI > 40,000) values were associated with impaired functional status and malnutrition. Conclusion: A BCI > 10,000 would appear to be a good biological prognostic factor for poor survival times and pre-existing geriatric impairment in older cancer patients before they initiate systemic treatment.
Highlights
Patients >65 years of age account for nearly 50% and 60% of new cancer cases in the USA and Europe, respectively [1]
We secondarily excluded 637 patients who were referred for surgery, radiotherapy only, or palliative care, 275 patients whose B12 vitamin blood level had not been assessed, 18 patients with no assessment of C-reactive protein blood levels, 13 patients aged under 70 years, and 18 patients lost to follow-up
The patients excluded from the analysis for lack of B12 or C-reactive protein (CRP) dosage or lost to follow-up were younger, had less prostatic and gastrointestinal cancers, and less metastatic stages than the included population
Summary
Patients >65 years of age account for nearly 50% and 60% of new cancer cases in the USA and Europe, respectively [1]. In the American Society of Clinical Oncology (ASCO) guidelines, the expert panel recommends using validated tools which assess specific geriatric domains in order to predict shorter survival times in older cancer patients receiving treatment. Recommendations for this population do not include using standardized biological analyses to estimate long-term prognosis [4]. The present study aimed to: (1) assess the prognosis value of the B12/CRP index (BCI) in a population of systemically treatable older patients with cancer and (2) analyze the association between BCI value and pre-existing geriatric frailty. Conclusion: A BCI > 10,000 would appear to be a good biological prognostic factor for poor survival times and pre-existing geriatric impairment in older cancer patients before they initiate systemic treatment
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