Six prognostic factors in the comprehensive geriatric assessment predicts overall survival
WEDNESDAY, Aug. 24 (HealthDay News) -- Six domains of comprehensive geriatric assessment (CGA) including age, albumin level, Eastern Cooperative Oncology Group (ECOG) performance status, geriatric depression scale (GDS) status, malnutrition risk, and disease stage are important predictors of overall survival (OS) in elderly Asian patients with cancer, according to a study published online Aug. 22 in the Journal of Clinical Oncology.
Ravindran Kanesvaran, M.D., from the National Cancer Centre Singapore, and colleagues investigated the impact of each CGA domain on OS in 249 patients with cancer (median age 77 years) who attended the outpatient geriatric oncology clinic at the National Cancer Center Singapore. They aimed to develop a prognostic scoring system by identifying signiﬁcant prognostic factors within the CGA by univariate and multivariate analyses. To predict OS, a simple nomogram was developed using regression coefﬁcients from the multivariate model. Harrell's c-index was used to assess concordance between predicted and observed responses of the individual patient score. Simulated data via bootstrap was used to perform calibration.
The investigators found that 14 CGA domains were significantly associated with OS on univariate analysis. On multivariate analysis age (hazard ratio [HR], 1.04), abnormal albumin level (HR, 1.97), abnormal GDS status (HR, 1.81), poor ECOG performance status (≥ 2 versus < 2: HR, 1.77), high malnutrition risk (high versus low risk: HR, 1.84), and advanced disease stage (late versus early: HR, 1.71) were identified as independent predictors of survival. The Harrell's c-index was approximately 0.71. Sets of 200 simulated data showed that the predicted outcomes of one-, two-, and three-year OS approximated the actual outcomes.
"This is the first study to comprehensively evaluate all domains of the CGA prospectively with respect to association with survival and to find six risk factors to be prognostic in an Asian context," the authors write.
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