By Chris Berrie
LUGANO, SWITZERLAND -- July 11, 2007 -- For elderly patients with lymphoma, the prognostic value of their performance status score overrides all other prognostic factors. Therefore, the prognostic indices currently used commonly in the general lymphoma population may not be of particular use in elderly patients, and it may be important to incorporate other geriatric factors in the assessment.
These findings, from an analysis of 731 Singapore-residents with lymphoma, were presented here on July 8th at the European Society for Medical Oncology (ESMO) Conference.
Principal Investigator Soon-Thye Lim, MD, Consultant Oncologist, Medical Oncology, National Cancer Centre, Singapore, Singapore, said, "A lot of the studies are looking at patients and thinking about a cut-off age of 60 as elderly, but we know that people are living much longer these days."
To better understand the characteristics and prognoses of elderly patients with lymphoma Dr. Lim and colleagues conducted a retrospective chart review of Singapore residents and compared patient characteristics across three age groups: <60 years; 61 to 74; and 75 or greater.
Results showed no significant differences in histological subtypes, except for a prevalence of Hodgkin's disease among patients aged <60 years.
Compared with patients < 60 years, those aged more than 60 years were more likely to present with advanced disease, extranodal involvement, elevated lactate dehydrogenase, low albumin, and Eastern Cooperative Oncology Group performance status (ECOG PS) 2 or more.
There were no significant differences between the two older age groups for any of the characteristics monitored, except for ECOG PS (P <.0001).
As expected across these three patient groups, the rates of estimated 5-year survivals differed significantly: 67% versus 37% versus 22%, respectively (P <.0001).
Multivariate analysis identified the following prognostic indicators for survival in patients <75: ECOG PS 2-4 (P <.0001); T-cell vs B cell histology (P <=.05); stage 3/4 disease (P <=.02)' high lactose dehydrogenase level (P =.02; 60 years or greater only) and low albumin level (P =.022; 61-74 years only).
However, for the group aged 75 years or greater, the only important factor that was prognostic for 5-year survival was the ECOG PS 2-4 (P <.004).
Dr. Lim said, "Perhaps it is also important what treatment you administer or what they have, but if they are of good health they will do well, and if they are of poor health no matter what you do, it seems that they will not do well."
He also noted that disease-free survival rates decreased significantly with increasing age (P <.001).
This analysis thus indicates that factors that are of use for prognosis in younger patients with lymphoma are do not have prognostic use for evaluation of patients older than 75 years.
"You have to incorporate certain geriatric factors, things that we may not so easily tease apart, like depression, functionality, social support… and not just from the psychological point of view, but there might be real subtle differences in their renal function, subtle differences in their cardiac function," Dr. Lim explained.
Dr. Lim stressed that ECOG PS should also be the single most important factor that influences treatment decisions in this patient group of patients with lymphoma.
[Presentation title: Performance Status Is the Single Most Important Prognostic Factor in Lymphoma Patients Aged Greater Than 75, Overriding Other Prognostic Factors Such as Histology. Abstract 65PD]
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