A multicentre analysis of the role of the G8 Screening Tool in the assessment of peri-operative and functional outcome in elderly patients with kidney tumours
Increasing life expectancy in the general population and the fact that a disproportional burden of cancer occurs in people age ≥ 65 years old have generated great interest in delivering better cancer care for older adults. EORTC and NCCN recommend that all patients with cancer age ≥ 70 years old should undergo some form of geriatric assessment. G8 Screening Tool is a robust geriatric tool to identify a geriatric risk profile and for prediction of functional decline and prognostic information for overall survival. We evaluated the role of G8 Screening Tool in the assessment of outcome of elderly patients (≥ 70 y.o.) underwent surgery for kidney tumours.
We prospectively enrolled 162 patients (≥ 70 years old at surgery date) from January 2012 to January 2016 underwent surgery at two urological institution. G8 Screening Tool was applied to each patient before surgery. We divided population into two groups (frail group vs. not-frail group) in relation to the geriatric risk profile based on G8 score (≤14 vs. > 14 respectively). The aim was to identify the role of G8 Score in predicting intraoperative, postoperative complications and functional outcomes.
A total of 70 females (34%) and 92 (46%) males were included in the analysis. 69 patients (42,6%) underwent PN, while 93 patients (57,4%) underwent RN. Mean age at surgery was 76.57 (SD±6,37). Comorbidity factors were included: mean CCI was 3.06 (SD±1,99) with CCI > 5 points in 18 patients (15,65%), mean BMI was 25,15 (SD±2,87), 55 patients (34%) with DM, 98 patients (60%) with HTN. CKD stage III was present in 73 patients (45,1%) underwent surgery. Mean ECOG PS was 1,53 (SD±0,66) with score ≥ 3 in 7 patients (6,1%). Mean ASA Score was 2,84 (SD±0,73). According to the G8 Score, 91 patients (60%) were included in the frail group and 71 (40%) in the not-frail group. 41 patients of frail group vs. 2 patients of not-frail group developed intraoperative complications (p<0,0001). 51 patients of frail group vs. 4 patients of not-frail group developed postoperative complications (p<0,0001). After a mean follow-up of 40,56 months, mean eGFR was 43,72 ml/min/1.73m2 (SD±21,49) in frail group vs. 47,53 ml/min/1.73m2 (SD±13,36) in not-frail group (p=0,015).</p>
G8 Screening Tool seems to be an effective and useful instrument to predict the risk of complications and functional outcomes in elderly patients candidate for kidney surgery. However, further investigations should be necessary to confirm the good potential of this tool.