Supplementary Material for: Comparing preoperative screening tools for elective urologic cancer surgery: insights from a cluster analysis

Introduction:
The aim of this study is to evaluate the features and benefits of different geriatric screening tools for enhancing the perioperative care of patients who undergo elective cancer surgery using cluster analysis.

Methods:
This study was a retrospective, observational analysis of 1019 consecutive patients who had elective major cancer surgery in the urology department of our hospital from October 2019 to January 2023. Before the surgery, a trained nurse screened the patients using six tools: Eastern Clinical Oncology Group performance status (ECOG-PS), flemish version of the triage risk screening tool (fTRST), geriatric-8 (G8), instrumental activities of daily living (IADL), patient health questionnaire-2 (PHQ-2), and simple questionnaire to rapidly diagnose sarcopenia (SARC-F). The study grouped the patients into four clusters based on their scores on these tools and compared their outcomes after the surgery. The outcomes included overall survival, ambulation failure, delirium, and severe complications. The study also examined how each screening tool was associated with the outcomes.

Results:
Based on their clinical data and screening results, we classified the patients into four groups: Healthy (73%), Depressive (11%), Intermediate (11%), and Unhealthy (5%). The Unhealthy group had the worst outcomes in overall survival (OS), ambulation failure, and delirium, followed by the Intermediate group. In addition, fTRST and SARC-F emerged as significant predictors of OS; ECOG-PS, fTRST, G8 and SARC-F of ambulation failure; ECOG-PS, fTRST and G8 of delirium; and G8 of severe complications.

Conclusion:
Various geriatric screening tools were found to have the potential to forecast diverse postoperative outcomes.

引言：本研究旨在通过聚类分析，评估不同老年筛查工具（geriatric screening tools）在优化择期癌症手术患者围手术期护理方面的应用价值与优势。
方法：本研究为回顾性观察性分析，纳入2019年10月至2023年1月于我院泌尿外科接受择期大型癌症手术的1019例连续入组患者。术前，由经过培训的护士采用6种工具对患者进行筛查：东部肿瘤协作组体能状态评分（Eastern Clinical Oncology Group Performance Status, ECOG-PS）、弗兰德版分诊风险筛查工具（Flemish Version of Triage Risk Screening Tool, fTRST）、老年综合评估8项量表（Geriatric-8, G8）、日常活动工具性能力量表（Instrumental Activities of Daily Living, IADL）、患者健康问卷-2（Patient Health Questionnaire-2, PHQ-2）以及快速诊断肌少症简易问卷（Simple Questionnaire to Rapidly Diagnose Sarcopenia, SARC-F）。本研究基于上述工具的评分将患者划分为4个聚类组，并对比各组术后结局。术后结局包括总生存期（Overall Survival, OS）、行走功能障碍、谵妄及严重并发症。本研究同时分析了每种筛查工具与上述术后结局的相关性。
结果：基于患者临床资料与筛查结果，本研究将患者分为4组：健康组（73%）、抑郁组（11%）、中间组（11%）及高危组（5%）。高危组在总生存期（OS）、行走功能障碍及谵妄方面的结局最差，其次为中间组。此外，fTRST与SARC-F可显著预测OS；ECOG-PS、fTRST、G8及SARC-F可预测行走功能障碍；ECOG-PS、fTRST及G8可预测谵妄；G8可预测严重并发症。
结论：本研究表明，多种老年筛查工具均具备预测不同类型术后结局的应用潜力。