The Pre-Operative GRADE Score Is Associated with 5-Year Survival among Older Patients with Cancer Undergoing Surgery
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design and Population
2.2. Pre-Operative Assessment
2.3. Post-Operative Outcomes
2.4. Statistical Analysis
3. Results
3.1. Patients
3.2. Baseline Characteristics of Patients
3.3. 30-Day Post-Operative Complications
3.4. Preoperative Factors Associated with 5-Year Post-Operative Mortality
3.5. Improvement of the GRADE Score: The GRADE-Surgery Score
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
GRADE | GRADE-Surgery |
---|---|
Weight loss ≥ 5% | GRADE > 8 |
No = 0 | No = 0 |
Yes = 1 | Yes = 3 |
Gait speed < 0.8 m/s | IADL ≤ ¾ * |
No = 0 | No = 0 |
Yes = 3 | Yes = 4 |
Cancer site | |
Colorectal = 3 | |
Non-breast gynaecological = 3 | |
Digestive non-colorectal = 4 | |
Cancer extension | |
Local = 0 | |
Locally-advanced = 3 | |
Metastatic = 5 | |
Total = 3–13 | Total = 0–7 |
C-index (threshold of 8) = 0.76 | C-index (threshold of 4) = 0.81 |
Scoring Systems | Study Population | Variables | Advantages | Disadvantages |
---|---|---|---|---|
PREOP [30] | 229 patients ≥ 70 years Cancer surgery: breast, colorectal, gastric, gynaecologic, pancreas and bile-duct, renal and bladder, soft tissue and skin | Total = 5 Sex, type of surgery, TGUG, ASA scale, NRS | Associated with 5-year overall survival Good discrimination (C-index = 0.78) | No external validation Time to scoring with NRS tool |
VESPA [32] | 476 patients ≥ 70 years Cancer-surgery: Dermatologic, gastrointestinal, urologic, breast, head and neck, ophtalmologic | Total = 6 ADL/IADL, self-report inability to manage oneself, sex, Charlson’s comorbidity index, complexity of surgery procedure | Associated with 30-day post-operative complications Very-good discrimination for geriatric complications (C-index = 0.83) Good discrimination for surgical complications (C-index = 0.70) Good discrimination for post-discharge needs (C-index = 0.77) The largest sample | No external validation Association with overall survival not reported Time to scoring with several scales |
GA-GYN [33] | 189 patients ≥ 70 years Cancer-surgery: Non-breast gynaecological | Total = 8 Need for assistance in taking medications, limited in walking one block, decreased social activity, number of falls, fair or worse hearing, age, hemoglobin, creatinine | Associated with 6-week post-operative complications (stage III/IV only) Specific to gynaecological cancers | No external validation Not associated with overall survival Time to scoring with biological variables Discrimination lacking |
GRADE [14] | 136 patients ≥ 65 years Cancer-surgery: colorectal, oesophagus, gastric, pancreas and bile-duct, anus, gastro-intestinal and stromal tumours, ovarian, uterus | Total = 4 Weight loss, Gait speed, Cancer site, Cancer extension | Associated with 5-year overall survival Good discrimination (C-index = 0.76) Univariate association with 30-day post-operative complications The simplest score Usefulness when a geriatric assessment is not available | No external validation The smallest sample |
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Variables | Whole Cohort | GRADE ≤ 8 | GRADE > 8 | p * |
---|---|---|---|---|
Low-Risk | High-Risk | |||
n = 136 (%) | n = 68 (%) | n = 68 (%) | ||
Age, y | ||||
Mean ± SD | 80 ± 7 | 78 ± 7 | 82 ± 7 | 0.0008 |
65–74 | 32 (23.5) | 20 (29) | 12 (18) | 0.09 |
75–84 | 66 (48.5) | 34 (50) | 32 (47) | |
≥85 | 38 (28) | 14 (21) | 24 (35) | |
Gender (male) | 71 (52) | 42 (62) | 29 (43) | 0.02 |
Outpatient (yes) | 108 (79) | 60 (88) | 48 (70) | 0.25 |
Cancer site: | 0.25 | |||
Colorectal | 99 (73) | 47 (69) | 52 (76) | |
Others † | 37 (27) | 21 (31) | 16 (24) | |
Local and locally-advanced cancer (yes) | 107 (79) | 62 (91) | 45 (66) | <0.0001 |
ASA scale > 2 | 60 (44) | 21 (31) | 39 (57) | 0.001 |
ECOG > 2 | 38 (28) | 9 (13) | 29 (43) | 0.0001 |
G8-index £ 14/17 (n = 133) | 112 (84) | 50 (73) | 62 (91) | 0.007 |
Comorbidities: | ||||
CIRSG total ≥ 14 | 67 (49) | 29 (43) | 38 (56) | 0.12 |
Polypharmacy (yes) | 88 (65) | 42 (62) | 46 (68) | 0.47 |
Dependency | ||||
ADL £ 5/6 | 45 (33) | 12 (18) | 33 (48) | 0.0001 |
IADL £ 3/4 | 76 (56) | 26 (38) | 50 (73) | <0.0001 |
Malnutrition | ||||
BMI < 21 kg/m2 (n = 134) | 18 (13) | 8 (12) | 10 (15) | 0.56 |
Depressed mood | ||||
Mini-GDS ≥ 1/4 | 51 (37.5) | 22 (32) | 29 (43) | 0.21 |
Cognition (n = 91) | ||||
MMSE < 24/30 | 41 (45) | 19 (28) | 22 (32) | 0.03 |
30-day post-operative complications | ||||
Clavien-Dindo ≥ 1 | 91 (67) | 41 (60) | 50 (73) | 0.1 |
Clavien-Dindo ≥ 3a (severe) | 50 (37) | 19 (28) | 31 (46) | 0.03 |
Variables | Univariate Analysis | Multivariate Analysis | ||||
---|---|---|---|---|---|---|
HR | (95% CI) | p * | aHR | (95% CI) | p * | |
Age (per 1 SD of more) | 1.05 | 1.01–1.10 | 0.02 | - | ||
Gender (male) | 0.61 | 0.34–1.09 | 0.09 | - | ||
Outpatients (yes) | 0.55 | 0.29–1.06 | 0.07 | - | ||
GRADE score | 0.0001 | |||||
≤8 (low risk) | 1 (reference) | – | 1 (reference) | - | 0.005 | |
>8 (high risk) | 3.47 | 1.85–6.54 | 2.64 | (1.34–5.21) | ||
ASA scale > 2 | 3.43 | 1.87–6.30 | <0.0001 | - | ||
ECOG-PS > 2 | 3.42 | 1.88–6.23 | <0.0001 | - | ||
G8-index £ 14/17 (n = 133) | 3.09 | 0.96–10.0 | 0.05 | - | ||
Comorbidities: | ||||||
CIRSG total ≥ 14 | 1.95 | 1.09–3.51 | 0.02 | - | ||
Polypharmacy (yes) | 1.63 | 0.86–3.10 | 0.13 | - | ||
Dependency | ||||||
ADL £ 5/6 | 2.22 | 1.24–3.98 | 0.007 | - | ||
IADL £ 3/4 | 4.32 | 2.13–8.73 | <0.0001 | 2.95 | (1.40–6.23) | 0.004 |
Malnutrition | ||||||
BMI < 21 kg/m2 (n = 134) | 2.66 | 1.35–5.25 | 0.004 | 2.97 | (1.49–5.93) | 0.002 |
Depressed mood | ||||||
Mini-GDS ≥ 1/4 | 1.88 | 1.06–3.33 | 0.03 | - | ||
Cognition (n = 91) | ||||||
MMSE < 24/30 | 2.61 | 1.18–5.73 | 0.01 | - |
Risk of Death | ||||||
---|---|---|---|---|---|---|
GRADE | Median Survival (Months) | 12 m | 24 m | 36 m | 50 m | 62 m |
≤8 (low risk) | NR | 8% | 13% | 22% | 29% | 29% |
>8 (high risk) | 34.2 (19.2–50.1) | 31% | 37% | 55% | 62% | 74% |
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Wind, P.; ap Thomas, Z.; Laurent, M.; Aparicio, T.; Siebert, M.; Audureau, E.; Paillaud, E.; Bousquet, G.; Pamoukdjian, F. The Pre-Operative GRADE Score Is Associated with 5-Year Survival among Older Patients with Cancer Undergoing Surgery. Cancers 2022, 14, 117. https://doi.org/10.3390/cancers14010117
Wind P, ap Thomas Z, Laurent M, Aparicio T, Siebert M, Audureau E, Paillaud E, Bousquet G, Pamoukdjian F. The Pre-Operative GRADE Score Is Associated with 5-Year Survival among Older Patients with Cancer Undergoing Surgery. Cancers. 2022; 14(1):117. https://doi.org/10.3390/cancers14010117
Chicago/Turabian StyleWind, Philippe, Zoe ap Thomas, Marie Laurent, Thomas Aparicio, Matthieu Siebert, Etienne Audureau, Elena Paillaud, Guilhem Bousquet, and Frédéric Pamoukdjian. 2022. "The Pre-Operative GRADE Score Is Associated with 5-Year Survival among Older Patients with Cancer Undergoing Surgery" Cancers 14, no. 1: 117. https://doi.org/10.3390/cancers14010117