综合老年学评估在老年急性髓系白血病患者中应用的多中心、前瞻性研究  

The usage of comprehensive geriatric assessment in elderly patients with acute myeloid leukemia:a multicenter,prospective study

作　　者：吴琪[1] 付蓉[2] 赵明峰[3] 马一盖[4] 江浩[5] 胡亮钉[6] 靖彧[7] 刘辉[8] 王立茹[9] 苏力[10] 张永清[11] 周春林 张岩[13] 任汉云[14] 江滨 周合冰[16] 康琳[1] 张路[1] 周道斌[1] 李剑[1] Wu Qi;Fu Rong;Zhao Mingfen;Ma Yigai;Jiang Hao;Hu Liangding;Jing Yu;Liu Hui;Wang Liru;Su Li;Zhang Yongqing;Zhou Chunlin;Zhang Yan;Ren Hanyun;Jiang Bin;Zhou Hebing;Kang Lin;Zhang Lu;Zhou Daobin;Li Jian(Peking Union Medical College Hospital,Beijing 100730,China;Xuanwu Hospital,Capital Medical University,Beijing 100053,China;the 309th Hospital of Chinese PLA,Beijing 100091,China;Blood Diseases Hospital,CAMS & PUMC,Tianjin 300020,China;Beijing Longfu Hospital,Beijing 100010,China;Peking University First Hospital,Beijing 100034,China;Peking University International Hospital,Beijing 102206,China;Beijing Luhe Hospital,Capital Medical Unversity,Beijing 101100,China;General Hospital,Tianjin Medical University,Tianjin 300052,China;Tianjin First Central Hospital,Tianjin 300192,China;China-Japan Friendship Hospital,Beijing 100029,China;People's Hospital,Peking University,Beijing 100044,China;307 PLA Hospital,Beijing 100071,China;Chinese PLA General Hospital,Beijing 100853,China;Beijing Hospital,Beijing 100730,China;Fuxing Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]中国医学科学院北京协和医院,100730 [10]首都医科大学宣武医院,北京100053 [11]解放军第309医院,北京100091 [12]中国医学科学院血液病医院(血液学研究所),天津300020 [13]北京隆福医院,100010 [14]北京大学第一医院,100034 [15]北京大学国际医院,102206 [16]首都医科大学附属北京潞河医院,101100 [2]天津医科大学总医院,300052 [3]天津市第一中心医院,300192 [4]中日友好医院,北京100029 [5]北京大学人民医院、北京大学血液病研究所,100044 [6]解放军第307医院,北京100071 [7]解放军总医院,北京100853 [8]卫生部北京医院,100730 [9]首都医科大学附属复兴医院,北京100038

出　　处：《中华血液学杂志》2019年第1期35-39,共5页Chinese Journal of Hematology

摘　　要：目的探讨综合老年学评估(CGA)在中国初治老年急性髓系白血病(AML)患者中应用的可行性及评估结果。方法前瞻性分析83例于2016年3月至2017年12月在京津地区16家医院住院治疗的非急性早幼粒细胞白血病的老年(年龄≥60岁)初治AML患者的临床资料、CGA结果、治疗和生存数据。结果83例患者中,81例(97.6%)完成了所有的CGA评价。中位CGA量表异常个数为2(0~6)个,16例(19.3%)患者无任何CGA量表异常。46例(55.4%)患者存在日常活动量表(ADL)异常,35例(42.2%)患者存在工具性日常生活活动量表(IADL)异常,40例(48.2%)患者存在简易营养评估量表(MNA-SF)异常,13例(15.7%)患者存在认知异常,26例(31.7%)患者存在老年抑郁量表(GDS)异常,16例(19.5%)患者存在造血干细胞移植共病指数(HCT-CI)异常。在46例(55.4%)美国东部肿瘤协作组(ECOG)体能评估正常的患者中,CGA量表的异常比例为6.5%~37.0%,其中32例患者存在≥1个CGA量表异常。生存分析发现CGA异常数目与患者的中位总生存相关(P=0.050)。结论在中国老年AML住院患者中行CGA具有临床可行性。Objective To evaluate the feasibility and potential value of comprehensive geriatric assessment (CGA) in elderly (≥60 years) patients with newly diagnosed acute myeloid leukemia (AML) in China.Methods The CGA results of 83 newly diagnosed AML (non-APL) patients from 16 hospitals in Beijing and Tianjin between March 2016 and December 2017 were prospectively collected and analyzed.The clinical data,treatment and follow-up information were also collected.Results Of 83 newly diagnosed elderly AML patients,81 patients (97.6%) completed all designated CGA assessment.The median number of impaired scales of the CGA assessment in the studied population was 2(0-6).Sixteen patients (19.3%) showed no impairments according to the geriatric assessment scales implem ented by this study.The distributions of impaired scales were as follows:impairment in ADL,55.4%;IADL impairment,42.2%;MNA-SF impairment,48.2%;cognitive impairment,15.7%;GDS impairment,31.7%;HCT-CI impairment,19.5%,respectively.In patients with "good" ECOG (n=46),the proportion of impairment for each CGA scale ranged from 6.5% to 37.0% and 32 patients (68.9%) had at least one impaired CGA scale.Survival analysis showed that the number of impaired scales of the CGA was significantly correlated with median overall survival (P=0.050).Conclusions CGA was a tool with feasibility for the comprehensive evaluation in elderly AML patients in China.Combined with age and ECOG,CGA may be more comprehensive in assessing patients’ physical condition.

关 键 词：综合老年学评估 白血病 髓样 急性 老年 

分 类 号：R733.71[医药卫生—肿瘤]