Association between frailty syndrome and survival in patients with pancreatic adenocarcinoma An Ngo‐Huang.pdf

该【Association between frailty syndrome and survival in patients with pancreatic adenocarcinoma An Ngo‐Huang 】是由【dt83088549】上传分享，文档一共【10】页，该文档可以免费在线阅读，需要了解更多关于【Association between frailty syndrome and survival in patients with pancreatic adenocarcinoma An Ngo‐Huang 】的内容，可以使用淘豆网的站内搜索功能，选择自己适合的文档，以下文字是截取该文章内的部分文字，如需要获得完整电子版，请下载此文档到您的设备，方便您编辑和打印。Received:10January2019?|?Revised:26March2019?|?Accepted:27March2019DOI:?Ngo‐Huang1?|HollyM.?Holmes2?|.?desBordes3?|NathanH.?Parker4,5?|David?Fogelman6?|.?Petzel5?|Juhee?Song7?|Eduardo?Bruera1?|.?Katz51DepartmentofPalliative,Rehabilitation,andIntegrativeMedicine,?TheUniversityofTexasMDAndersonCancerCenter,Houston,Texas2DivisionofGeriatricandPalliativeMedicine,McGovernMedicalSchool,?TheUniversityofTexasHealthScienceCenter,Houston,Texas3DepartmentofGeneralInternalMedicine,?TheUniversityofTexasMDAndersonCancerCenter,Houston,Texas4DepartmentofBehavioralScience,?TheUniversityofTexasMDAndersonCancerCenter,Houston,Texas5DepartmentofSurgicalOncology,?TheUniversityofTexasMDAndersonCancerCenter,Houston,Texas6DepartmentofGastrointestinalMedicalOncology,?TheUniversityofTexasMDAndersonCancerCenter,Houston,Texas7DepartmentofBiostatistics,?TheUniversityofTexasMDAndersonCancerCenter,Houston,TexasCorrespondenceAnNgo‐Huang,DepartmentofPalliative,AbstractRehabilitation,andIntegrativeMedicine,Background:Frailtyisasyndromecharacterizedbyweakness,slowgait,weightTheUniversityofTexasMDAndersonloss,exhaustion,-CancerCenter,beBoulevard,Unit1414,Houston,-Email:******@carcinoma(PDAC),:(perFriedcriteria)wasdefinedashavingthreeormoreabnormalitiesin:gripstrength,gaitspeed,weightloss,self‐reportedexhaustion,orself‐,ana-tomicstage,performancestatus,,frailty,andsurvivalwasdeter-,orbidities,andperformancestatuswereexamined.-:Of150patientsenrolled,?years(range,32‐89).Seventy‐ninepa-tients(%)weresarcopenic,and36(%)(P?=?)andworseperformancestatus(P?<?).AnNgo‐‐’OncologieGeriatrique(SIOG)—HolmesHM,FogelmanDR,desBordesJK,CooperAB,LuoR,;4:,whichpermitsuse,distributionandreproductioninanymedium,providedtheoriginalworkisproperlycited.?&SonsLtd./journal/cam4?|?1?;1–?|???NGO‐‐up,79patients(56%)‐upperiod(P?<?)fortheentirecohort,includingpatientswithcurative(P?=?)andpalliative(P?=?):,,frailty,geriatricassessment,geriatricsyndromes,pancreaticadenocarcinoma1?|?INTRODUCTIONcandidatesfoundthatself‐reportedexhaustion(acompo-nentofthefrailtysyndrome)wasindependentlyassociatedanceristypicallyadiseaseofolderpersons,plications,withamedianageatpresentationof71?,-Olderpatientsbenefitfromtherapythatincludesresection,sureswereassociatedwithalowerlikelihoodofdischargetobutstudieshavehistoricallyshownhigherrisksofperioper-(usingFriedfrailtycriteria)inpatientswithnewlytoreceivecurativetherapythatincludesresection,olderpa-diagnosedpancreaticductaladenocarcinoma(PDAC),andtientswhoareactuallyselectedforsurgerymaybeamongtodeterminewhetherfrailtywasassociatedwithincreasedmonage‐,3hypothesizedthatthepresenceoffrailtyatinitialdiagnosisAfterundergoingsurgeryforcancer,olderpersonsarewouldbeassociatedwithmoreadvancedcancerstage,withesincludingpostop-pletecurativetherapy(ie,multimodal-plications,dischargetoalocationotherthanitytreatmentincludingsurgicalresection),andwithdeathhome,‐re-within1?,wesoughttoexplorewhetherlatedvulnerabilitiesmayaidinprognosticationandinfrailtycriteriawerecorrelatedwithobjectivemeasuresofputedtomography(CT)scans,-ancermightfacilitateroutineintegrationoffrailtyassessmedical,functional,physical,andpsychosocialsta-,weenrolledmendedtodetermineoptimalcareforallpatientswithnewlydiagnosedPDACofallstagesintoapro--,dischargelocationotherthanhome,declineinfunctionalstatus,longerlengthofhospitalstay,?|?PATIENTSANDMETHODSesinpan-ancerischallenging,?|?PatientrecruitmentancerfrequentlypresentwithThisstudywasapprovedbyTheUniversityofTexasMDcachexiaandfunctionaldeclineatbaseline,aclinicalpresen-AndersonCancerCenterInstitutionalReviewBoard(IRBmonlyassociated#2012‐0318),andourresearchmettherequirementsforpro-,,?yearsahigherriskoffunctionaldeclineandmortalityinolderper-andolderwithnewlydiagnosed,-‐HUANGetal.???|?--Group(ECOG)-vestigatorscreenedforpotentiallyeligiblepatients,,baselineCA19‐9level,albumin,andtotalofpatients,inordertoprovideblindingofthestageofpan--sectionwasplanned,withorwithoutchemotherapyand/?|?(a)heassocia-surgicalcandidateswerecategorizedashavingapalliativetionoffrailtywithcancerstageorage,and(b)‐sec-,intramuscularfat,visceralwastodeterminewhetherfrailtywassignificantlyassociatedfat,-thedefinitionforaphenotypeoffrailtybasedonFriedcrite-,software(Tomo‐Vision,2012).Cross‐sectionalareasgripstrength,weightloss,exhaustion,-Radiographicevidenceofsarcopeniawasdefinedasskele-mentswereabnormal,≤?cm2/m2forwomenand≤?cm2/Gaitspeedwasdeterminedbya3‐mtimedwalk,?secondsorlongertowalk3?-?|?StatisticalmethodsordingtobodymassFordeterminingtheassociationoffrailtywithcancerstageindex(BMI).11Weightloss(byself‐report)wasconsideredorage(objective1),parisonsweretheabnormalifapatientreportedlosing3?reaterintheassociationsbetweenfrailtyandincreasingageandbetweenprior3?‐(CES‐D)scale,andexhaustionwascon-“everythingallbaselinecharacteristicsbypatientstatusasnotfrailorIdidwasaneffort”orthepatient“couldnotgetgoing”,paredtheproportionmoderateamountoftimeorformostofthetimeinthepastwhowerefrailornotfrailbyusingchi‐,-InternationalPhysicalActivityQuestionnaire(IPAQ),whichsociationswithfrailty,theCochran‐Armitagetestfortrendquantifiestheamountoftimeintheprior7?daysthatapersonwasusedtoconfirmasignificanttrendintheassociationspentdoingvigorous,moderate,-IPAQwasusedtocalculatethemetabolicequivalentoftask‐variates,weusedttestsfornormallydistributedvariablesminutesperweekforeachpatient;-,gender,race/eth-withsurvivalinpatientswithresectablecanceratpresenta-nicity,BMI,orbiditywasdeterminedtion(objective2),onlypatientswithacurativeplanofcareorbidityEvaluation(ACE‐27),‐itemsystem‐orbidityasdefinedasthetimeintervalfromdiagnosistodeath,censorednone(0),mild(1),moderate(2),orsevere(3).14Anatomicatlastfollow‐-Kaplan‐MeiergraphsandCoxproportionalhazardsmod-tiallyresectable,borderlineresectable,locallyadvanced,elsforoverallsurvivalwereevaluatedforthepresenceoformetastatic,asdeterminedbytheprimaryoncologyteamfrailty,orbidity,anatomicstage,,alongwiththereceiptofanypreoperativechemo-determinedperformancestatusatpresentation,whichwastherapyorcurativeresection(pancreaticoduodenectomyor4?|???NGO‐?Studyenrollmentflowchartpancreatectomy).,orbid-compositionwasdeterminedwithuseofttestsorwithity(testfortrend,P?<?).FrailtywasalsoassociatedpositionvariableswithworseECOGperformancestatus,withahigherpreva--lenceoffrailtybyworseperformancestatus(testfortrend,sitionweremeasuredincentimeterssquaredandthencor-P?<?).,race,BMI,CA19‐9,albumin,bilirubinlev-pletedwiththeuseofStata12els,orchemotherapyregimen.(StataCorp,CollegeStation,TX);monabnormalityonthef