Page 120 - Risk quantification and modification in older patients with colorectal cancer
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Chapter 6
Tumour Location
Colon
Rectum
Tumour stage
I
II
III
Surgical Approach
Laparoscopic
Open
Geriatic
Katz ADL (mean. SD)
score ≥2 Reported Falls
Risk for Malnutrition
Risk for Delirium (mean. SD)
Delirium Score ≥1
Medication Use (mean. SD)
Polypharmacy (No. ≥5)
Preoperative Use of a Mobility Aid
- 818 (75) - 270 (25)
- 336 (31) - 411 (38) - 341 (31)
- 877 (81) - 211 (19)
120 (15) 51 (19)
54 (16) 63 (15) 54 (16)
119 (14) 52 (25)
reference
1.35 (0.94-1.94)
reference
0.95 (0.64-1.04) 0.98 (0.65-1.48)
reference
2.08 (1.44-3.01)
1.38 (1.18-1.61)
2.97 (1.73-5.11) 1.19 (0.74-1.92) 1.35 (0.90-2.02)
1.69 (1.34-2.12)
2.38 (1.65-3.42) 1.1 (1.05-1.56)
2.18 (1.55-3.07) 2.39 (1.64-3.47)
698 (85) 219 (81)
282 (84) 348 (85) 287 (84)
758 (86) 159 (75)
0.2 (0.7)
43 (66) 105 (81) 156 (73)
0.2 (0.6)
154 (73)
18 4 (0- 5 (0-
17) 17) 16)
0.099
0.78 0.93
<0.001
<0.001
<0.001 0.47 0.1
<0.001
<0.001 <0.001
<0.001 <0.001
15 0.3 (0.8) 0.5 (1.3)
65 (6) 76 129 (12) 12 215 (20)
22 (34) 24 (19) 37 (17)
18 0.3 (0.6) 0.5 (0.8)
210 (19) 56 (27)
490 (45) 103 (21) 21 191 (18) 51 (27)
387 (79) 116 (61)
Mean with Standard Deviation (SD). median with (range) and frequencies with percentage (%).
Odds Ratio's with 95% Confidence Interval (CI). a PE, pulmonary Embolism; DVT, Deep Venous Thrombosis
When the predictors Katz ADL (instead of self-reported ADL assistance) and risk for delirium (score ≥1) were included as candidate predictors in the geriatric model, this yielded an AUC of 0.69 (95% CI 0.65-0.73) after internal validation and 0.65 in the optimism corrected model. Judged by its clinical applicability, we used the first model (with self-reported ADL assistance) for further risk score development.
Clinical Prediction Model
For the development of a clinically useful prediction model and tool, the regression coefficients from the geriatric model were used to develop the Geriatric Colorectal Cancer Model (GerCRC). After rounding, age (every 10 years, b=0.04), ASA score (b=0.02) and self-reported cognitive impairment (b=0.09) were omitted due to their marginal effect (b<0.1).
118
4 (0-
