Prognostic value of baseline functional status measures and geriatric screening in vulnerable older patients with metastatic colorectal cancer receiving palliative chemotherapy: The randomized NORDIC9-study

Gabor Liposits, Jesper Ryg, Halla Skuladottir, Stine B. Winther, Sören Möller, Eva Hofsli, Carl Henrik Shah, Laurids Østergaard Poulsen, Åke Berglund, Camilla Qvortrup, Pia Osterlund, Bengt Glimelius, Halfdan Sorbye, Per Pfeiffer

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    Abstract

    Introduction: Appropriate patient selection based on functional status is crucial when considering older adults for palliative chemotherapy. This pre-planned analysis of the randomized NORDIC9-study explored the prognostic value of four functional status measures regarding progression-free survival (PFS) and overall survival (OS) in vulnerable older patients with metastatic colorectal cancer (mCRC) receiving first-line palliative chemotherapy. Materials and methods: Patients ≥70 years of age with mCRC not candidates for standard full-dose combination chemotherapy were randomized to receive full-dose S1 or reduced-dose S1 + oxaliplatin. At baseline, functional status was assessed using ECOG performance status (ECOG PS), frailty phenotype, Geriatric 8 (G8), and Vulnerable Elderly Survey-13 (VES-13). Multivariable regression models were applied and C-statistics were estimated. Results: In total, 160 patients with a median age of 78 years (IQR: 76–81) were included. While in univariate analyses, ECOG PS, frailty phenotype, and VES-13 were statistically significantly associated with differences in OS between subgroups, G8 was not (HR = 1.55, 95%CI: 0.99–2.41, p = 0.050). In multivariable analyses adjusted for age, sex, body mass index, and treatment allocation, we found significant differences between subgroups for all applied tools and with C-statistics in the moderate range for ECOG PS and VES-13. Concerning PFS, statistically significant differences were observed between subgroups of ECOG PS, G8, and VES-13 both in uni- and multivariable analyses, but not for frailty phenotype. Discussion: In this Nordic cohort of vulnerable older patients with mCRC, baseline ECOG PS, frailty phenotype, G8, and VES-13 showed prognostic value regarding overall survival, and moderate predictive value of models based on ECOG PS and VES-13 was demonstrated.

    Original languageEnglish
    JournalJOURNAL OF GERIATRIC ONCOLOGY
    DOIs
    Publication statusAccepted/In press - 2022
    Publication typeA1 Journal article-refereed

    Keywords

    • Chemotherapy
    • Colorectal cancer
    • ECOG performance status
    • Frailty phenotype
    • Functional status
    • Geriatric 8
    • Older adults
    • Prognosis
    • Survival
    • Vulnerable Elderly Survey-13

    Publication forum classification

    • Publication forum level 0

    ASJC Scopus subject areas

    • Oncology
    • Geriatrics and Gerontology

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