Development and Validation of a Risk Tool for Predicting Severe Toxicity in Older Adults Receiving Chemotherapy for Early-Stage Breast Cancer

被引：85

作者：

Magnuson, Allison ^{[1
]}

Sedrak, Mina S. ^{[2
]}

Gross, Cary P. ^{[3
]}

Tew, William P. ^{[4
]}

Klepin, Heidi D. ^{[5
]}

Wildes, Tanya M. ^{[6
]}

Muss, Hyman B. ^{[7
]}

Dotan, Efrat ^{[8
]}

Freedman, Rachel A. ^{[9
]}

O'Connor, Tracey ^{[10
]}

Dale, William ^{[2
]}

Cohen, Harvey J. ^{[11
]}

Katheria, Vani ^{[2
]}

Arsenyan, Anait ^{[2
]}

Levi, Abrahm ^{[2
]}

Kim, Heeyoung ^{[2
]}

Mohile, Supriya ^{[1
]}

Hurria, Arti ^{[2
]}

Sun, Can-Lan ^{[2
]}

机构：

[1] Univ Rochester, Rochester, NY 14642 USA

[2] City Hope Natl Med Ctr, Duarte, CA USA

[3] Yale Sch Med, New Haven, CT USA

[4] Mem Sloan Kettering Canc Ctr, 1275 York Ave, New York, NY 10021 USA

[5] Wake Forest Sch Med, Winston Salem, NC 27101 USA

[6] Washington Univ, Sch Med, St Louis, MO USA

[7] UNC Lineberger Comprehens Canc Ctr, Chapel Hill, NC USA

[8] Fox Chase Canc Ctr, 7701 Burholme Ave, Philadelphia, PA 19111 USA

[9] Dana Farber Canc Inst, Boston, MA 02115 USA

[10] Roswell Park Canc Inst, Buffalo, NY 14263 USA

[11] Duke Univ, Med Ctr, Durham, NC USA

来源：

JOURNAL OF CLINICAL ONCOLOGY | 2021年 / 39卷 / 06期

关键词：

ADJUVANT CHEMOTHERAPY; GERIATRIC ASSESSMENT; SOCIAL SUPPORT; ELDERLY-WOMEN; MORTALITY; INFORMATION; RELIABILITY; STATISTICS; OUTCOMES; MODEL;

D O I：

10.1200/JCO.20.02063

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

PURPOSE Limited tools exist to predict the risk of chemotherapy toxicity in older adults with early-stage breast cancer. METHODS Patients of age >= 65 years with stage I-III breast cancer from 16 institutions treated with neoadjuvant or adjuvant chemotherapy were prospectively evaluated for geriatric and clinical features predictive of grade 3-5 chemotherapy toxicity. Logistic regression with best-subsets selection was used to identify and incorporate independent predictors of toxicity into a model with weighted variable scoring. Model performance was evaluated using area under the ROC curve (AUC) and goodness-of-fit statistics. The model was internally and externally validated. RESULTS In 473 patients (283 in development and 190 in validation cohort), 46% developed grade 3-5 chemotherapy toxicities. Eight independent predictors were identified (each assigned weighted points): anthracycline use (1 point), stage II or III (3 points), planned treatment duration. 3 months (4 points), abnormal liver function (3 points), low hemoglobin (3 points), falls (4 points), limited walking (3 points), and lack of social support (3 points). We calculated risk scores for each patient and defined three risk groups: low (0-5 points), intermediate (6-11 points), or high (>= 12 points). In the development cohort, the rates of grade 3-5 chemotherapy toxicity for these three groups were 19%, 54%, and 87%, respectively (P < .01). In the validation cohort, the corresponding toxicity rates were 27%, 45%, and 76%. The AUC was 0.75 (95% CI, 0.70 to 0.81) in the development cohort and 0.69 (95% CI, 0.62 to 0.77) in the validation cohort. Risk groups were also associated with hospitalizations and reduced dose intensity (P < .01). CONCLUSION The Cancer and Aging Research Group-Breast Cancer (CARG-BC) score was developed and validated to predict grade 3-5 chemotherapy toxicity in older adults with early-stage breast cancer. (C) 2021 by American Society of Clinical Oncology

引用

页码：608 / +

页数：26

共 42 条

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