A Novel Geriatric Screening Tool in Older Patients with Cancer: The Korean Cancer Study Group Geriatric Score (KG)-7

<div><p>Geriatric assessment (GA) is resource-consuming, necessitating screening tools to select appropriate patients who need full GA. The objective of this study is to design a novel geriatric screening tool with easy-to-answer questions and high performance objectively selected from a large dataset to represent each domain of GA. A development cohort was constructed from 1284 patients who received GA from May 2004 to April 2007. Items representing each domain of functional status, cognitive function, nutritional status, and psychological status in GA were selected according to sensitivity (SE) and specificity (SP). Of the selected items, the final questions were chosen by a panel of oncologists and geriatricians to encompass most domains evenly and also by feasibility and use with cancer patients. The selected screening questions were validated in a separate cohort of 98 cancer patients. The novel screening tool, the Korean Cancer Study Group Geriatric Score (KG)-7, consisted of 7 items representing each domain of GA. KG-7 had a maximal area under the curve (AUC) of 0.93 (95% confidence interval (CI) 0.92−0.95) in the prediction of abnormal GA, which was higher than that of G-8 (0.87, 95% CI 0.85–0.89) within the development cohort. The cut-off value was decided at ≤ 5 points, with a SE of 95.0%, SP of 59.2%, positive predictive value (PPV) of 85.3%, and negative predictive value (NPV) of 82.6%. In the validation cohort, the AUC was 0.82 (95% CI 0.73−0.90), and the SE, SP, PPV, and NPV were 89.5%, 48.6%, 77.3%, and 75.0%, respectively. Furthermore, patients with higher KG-7 scores showed significantly longer overall survival (OS) in the development and validation cohorts. In conclusions, the KG-7 showed high SE and NPV to predict abnormal GA. The KG-7 also predicted OS. Given the results of our studies, the KG-7 could be used effectively in countries with high patient burden and low resources to select patients in need of full GA and intervention.</p></div

The distribution of KG-7 score according to GA status in development cohort.

<p>The distribution of KG-7 score according to GA status in development cohort.</p

Selection process of representative items in each domain.

<p>Selection process of representative items in each domain.</p

Overall survival according to KG-7 score in development cohort.

<p>(A) According to each KG-7 score. (B) According to categorized KG-7 score. (C) Between normal and abnormal KG-7 score.</p

Estimated overall survival probability stratified based on receipt of postoperative chemoradiotherapy in (a) an entire cohort (n = 190) and (b) a propensity score-matched cohort (n = 100).

<p>Estimated overall survival probability stratified based on receipt of postoperative chemoradiotherapy in (a) an entire cohort (n = 190) and (b) a propensity score-matched cohort (n = 100).</p

Estimated local control probability stratified based on receipt of postoperative chemoradiotherapy in (a) the entire cohort (n = 190) and (b) a propensity score-matched cohort (n = 100).

<p>Estimated local control probability stratified based on receipt of postoperative chemoradiotherapy in (a) the entire cohort (n = 190) and (b) a propensity score-matched cohort (n = 100).</p

Estimated local control probability stratified based on receipt of postoperative chemoradiotherapy in (a) low-risk patients (n = 129) and (b) high-risk patients (n = 61).

<p>Estimated local control probability stratified based on receipt of postoperative chemoradiotherapy in (a) low-risk patients (n = 129) and (b) high-risk patients (n = 61).</p

Estimated overall survival probability stratified based on receipt of postoperative chemoradiotherapy in (a) low-risk patients (n = 129) and (b) high-risk patients (n = 61).

<p>Estimated overall survival probability stratified based on receipt of postoperative chemoradiotherapy in (a) low-risk patients (n = 129) and (b) high-risk patients (n = 61).</p

Impact of Lymph Node Ratio on Oncologic Outcomes in ypStage III Rectal Cancer Patients Treated with Neoadjuvant Chemoradiotherapy followed by Total Mesorectal Excision, and Postoperative Adjuvant Chemotherapy

<div><p>Purpose</p><p>To evaluate the prognostic impact of the lymph node ratio (LNR) in ypStage III rectal cancer patients who were treated with neoadjuvant chemoradiotherapy (NCRT).</p><p>Materials and Methods</p><p>We retrospectively reviewed the data of 638 consecutive patients who underwent NCRT followed by total mesorectal excision, and postoperative adjuvant chemotherapy for rectal cancer from 2004 to 2011. Of these, 125 patients were positive for lymph node (LN) metastasis and were analyzed in this study.</p><p>Results</p><p>The median numbers of examined and metastatic LNs were 17 and 2, respectively, and the median LNR was 0.143 (range, 0.02–1). Median follow-up time was 55 months. In multivariate analyses, LNR was an independent prognostic factor for overall survival (OS) (hazard ratio [HR] 2.17, <i>p</i> = 0.041), disease-free survival (DFS) (HR 2.28, <i>p</i> = 0.005), and distant metastasis-free survival (DMFS) (HR 2.30, <i>p</i> = 0.010). When ypN1 patients were divided into low (low LNR ypN1 group) and high LNR (high LNR ypN1 group) according to a cut-off value of 0.152, the high LNR ypN1 group had poorer OS (<i>p</i> = 0.043) and DFS (<i>p</i> = 0.056) compared with the low LNR ypN1 group. And there were no differences between the high LNR ypN1 group and the ypN2 group in terms of the OS (<i>p</i> = 0.703) and DFS (<i>p</i> = 0.831).</p><p>Conclusions</p><p>For ypN-positive rectal cancer patients, the LNR was a more effective prognostic marker than the ypN stage, circumferential resection margin, or tumor regression grade after NCRT, and could be used to discern the high-risk group among ypN1 patients.</p></div

Kaplan-Meier curves for (A) overall survival and (B) disease-free survival for all patients.

<p>Kaplan-Meier curves for (A) overall survival and (B) disease-free survival for all patients.</p