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Master Thesis

(Index B12XCRP) et impact sur le devenir des patients âgés de plus de 70 ans atteints de cancer et pris en charge en ambulatoire dans un hôpital de jour d'oncogériatrie

Abstract : For a long time, older cancer patients have been treated according to their physiological age regardless of their state of health. A pretreatment Comprehensive Geriatric Assessment (CGA) has been proposed to assess prognosis and to adapt oncological care. However, few biological markers are incorporated in the medical decision. Our monocentric, retrospective, comparative study on 621 older cancer patients with a median age of 81 years (range 70 to 98 years) highlighted high serum vitamin B12 levels (HCbl) and the serum vitamin B12-CRP index (BCI) as prognostic factors of early death and early hospitalization. According to the multivariate analysis, HCbl is a prognostic factor of mortality within 3 months (OR 5.59; 95% CI; [1.94-15.94], p = 0.001) and 12 months (OR 5.16; 95% CI; [2.19-12.18], p = 0.0001). BCI is a prognostic factor of mortality (OR 4.43; 95% CI; [1.22-15.02], p = 0.02) and unexpected hospitalization within 3 months (OR 4.2; 95% CI; [1.7-10.28], p = 0.001). Other factors such as a Body Mass Index of 18 to 21 kg/m2 (OR 2.92; 95% CI; [1-8.08], p = 0.04), mobility with gait speed (OR 3.59; 95% CI; [1.42-9.43], p = 0.007) or palliative treatment (OR 13.66; 95% CI; [3.96-46.43], p < 0.0001) have a pejorative impact on 3-month mortality. In the same way, timed up and go test (OR 3.66; 95% CI; [1.83-7.41], p = 0.0002)) and palliative treatment (OR 5.07; 95% CI; [1.81-14.21], p = 0.002) have an impact on 12-month mortality. Regarding early hospitalizations, the metastatic status (OR 2.07; 95% CI; [1.02-4.22], p = 0.04) and performance status (PS) (OR 2.18; 95% CI; [1.05-4.5], p = 0.03) are prognostic factors during the first month; activities of daily living (ADL) (OR 1.85; 95% CI; [1.05-4.39], p = 0.03) is a prognostic factor during the first 3 months of treatment. In patients aged over 70 years with cancer, HCbl, BCI, BMI, mobility, and palliative treatment predicted early death. BCI, metastatic status, and PS predicted early hospitalization during the first month, and BCI and ADL during the first 3 months. We recommend determining serum vitamin B12 levels and BCI routinely as part of a pretreatment workup in older cancer patients in order to access more precisely the early hospitalization and death risk profile.
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https://dumas.ccsd.cnrs.fr/dumas-02388920
Contributor : Faculté de Médecine Amu <>
Submitted on : Monday, December 2, 2019 - 11:23:36 AM
Last modification on : Friday, October 23, 2020 - 4:58:59 PM
Long-term archiving on: : Tuesday, March 3, 2020 - 10:23:07 PM

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Eddy Puchades. (Index B12XCRP) et impact sur le devenir des patients âgés de plus de 70 ans atteints de cancer et pris en charge en ambulatoire dans un hôpital de jour d'oncogériatrie. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02388920⟩

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