| Objectives Modified Cumulative Illness Rating Scale-Geriatric(MCIRS-G) was adopted to evaluate the prevalence of comorbidity and its impact on chemotherapy in elderly patients with the digestive tract cancer.The clinical value of MCIRS-G used in elderly patients with gastrointestinal cancer was studied,and the correlation between MCIRS-G score and KPS score was also studied.Methods From October 2006 to September 2007,patients with the digestive tract cancer treated with fluorouracil-based combination chemotherapy were divided into the elderly group(≥65 years) and the control group(＜65 years).MCIRS-G was used to note down comorbidities in detail.CTCAE Version 3.0 was used to evaluate the adverse effects from the beginning of the treatment to the end of the consequential four weeks.Neurotoxicity was assessed by Levi's grading standards.Adverse reactions caused by chemotherapy of the two groups were compared according to the MCIRS-G scores,KPS scores and age stratification to study the differences.All the data was processed through the software SPSS 12.0.Results The study included 80 patients.37 old patients were enrolled in the elderly group,their ages ranged from 65 to 81(M=68);There were 43 patients in the control group,their ages ranged from 32 to 64(M=58).28 patients had combordities in the elderly group(28/40),while 16 in the control group(16/37).There was a significant difference of the prevalence of comorbidity between the two groups(P＜0.05).The score of MCIRS-G in the elderly group(16.194±2.25) was significantly higher than that of in the control group(14.67±1.08),Z=3.39,P＜0.001.Patients were divided into 3 groups according to the age(32～64,65～74,≥75),the numbers of systems with comorbidities(P =0.000) changed with age notably.There were no cases with severe comorbidities(levels 4-5)in the control group and there were no discrepancy between the numbers of systems with severe comorbidities(levels 4-5) in the elderly sub-groups(P =0.996 ).Hypertension(12/37) and hyperplasia of prostate(13/37) was the most common combordity in the elderly groups.Cholecystolithiasis had the highest incidence rate in the control group(5/43).The main adverse reactions of the patients were hematotoxicity,gastrointestinal toxicity.None was died of chemotherapy.There was noⅣand very fewⅢ(4/80) adverse reactions.There were no statistical discrepancies between the two groups according to the age stratification(P＞0.05 ). With the increase in MCIRS-G score,there were marked hematotoxicity incidences of leukopenia(P=0.014),thrombocytopenia(P=0.010),anemia(P=0.031) in the elderly group,incidence rates of other toxicities were very low.On the other hand,with the increases in MCIRS-G scores,the control group exhibited distinct change in the incidence of anemia(P=0.012).With the increases in KPS scores,the incidence rates ofthrombocytopenia(P=0.135),diarrhea(P=0.336) and leukopenia(P=0.726) decreased slightly in the elderly group,while only the incidence of diarrhea (P=0.133) decreased in the control group,the incidence of leukopenia increased contrarily(P=0.374).There was a positive correlation between MCIRS-G score and age,P=0.004,and there was noncorrelation between MCIRS-G score and KPS, P=0.375.Conclusion The MCIRS-G could be used to evaluate comorbidity of the elderly patients with digestive tract cancer effectively,MCIRS-G score was related to both adverse reactions and age,but there were no correlation between the scores of MCIRS -G and KPS.MCIRS-G tended to be a more sensitive prognostic factor compared to KPS.MCIRS-G could be used to predict the safety of chemotherapy in elderly patients and to give instructions to treatment.Age should not be regarded as a restriction factor of chemotherapy while comorbidity should be. |
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