O'Connell Jessica B, Maggard Melinda A, Ko Clifford Y
Department of Surgery, David Geffen School of Medicine, University of California-Los Angeles, 10833 Le Conte Avenue, Room 72-215, Los Angeles, CA 90095, USA.
Ann Surg Oncol. 2004 Nov;11(11):962-9. doi: 10.1245/ASO.2004.03.052. Epub 2004 Oct 15.
Previous studies report underuse of radiation and chemotherapy in the elderly, yet few have examined the rates of use (or underuse) of surgery. Using national data, we examined rates of surgical resection for patients with local-stage cancers.
By using the Surveillance, Epidemiology, and End RESULTS database (1988-1997), patients (> or =40 years) were identified with localized adenocarcinoma of the breast, esophagus, stomach, pancreas, colon, or rectum; non-small-cell lung carcinoma; and sarcoma (n = 200,360). Rates of cancer-directed surgery (CDS) were compared across age groups (at 5-year intervals). Multivariate regression was used to identify predictors of receipt of CDS in each tumor group.
Rates of CDS declined steadily with increasing age for all nine localized tumors. Most striking were the low rates of CDS for patients >70 years with esophagus, stomach, pancreas, and lung cancers (range, 0%-83%). However, CDS rates were >90% for breast and colon and >84% for rectal cancer in all age groups. Multivariate regression found lower odds of CDS for elderly patients for all cancers except colon. For example, age significantly decreased the odds of receiving CDS beginning at 60 years for lung cancer (odds ratio [OR], .550; P = .03), at 70 years for liver cancer (OR, .109; P = .003), and at 80 years for pancreatic cancer (OR, .120; P < .05).
Although CDS for localized disease is being performed regularly in the elderly for some cancers (e.g. breast, colon, and rectum), this analysis shows that elderly patients are not receiving surgery for many potentially curable cancers. Whether these rates are appropriate or too low requires further evaluation. This is particularly essential because our population is aging.
以往研究报告称老年人较少接受放疗和化疗，但很少有研究调查手术的使用（或未充分使用）率。我们利用全国性数据，研究了局部期癌症患者的手术切除率。
通过使用监测、流行病学和最终结果数据库（1988 - 1997年），确定年龄≥40岁的患有乳腺、食管、胃、胰腺、结肠或直肠癌的局限性腺癌、非小细胞肺癌和肉瘤的患者（n = 200,360）。比较各年龄组（以5年为间隔）的癌症定向手术（CDS）率。采用多变量回归分析确定每个肿瘤组接受CDS的预测因素。
所有9种局限性肿瘤的CDS率均随年龄增长而稳步下降。最显著的是，70岁以上食管癌、胃癌、胰腺癌和肺癌患者的CDS率较低（范围为0% - 83%）。然而，所有年龄组乳腺癌和结肠癌的CDS率>90%，直肠癌的CDS率>84%。多变量回归分析发现，除结肠癌外，所有癌症老年患者接受CDS的几率较低。例如，年龄从60岁开始显著降低肺癌接受CDS的几率（优势比[OR]，0.550；P = 0.03），70岁开始降低肝癌接受CDS的几率（OR，0.109；P = 0.003），80岁开始降低胰腺癌接受CDS的几率（OR = 0.120；P < 0.05）。
虽然对于某些癌症（如乳腺癌、结肠癌和直肠癌），老年人中针对局限性疾病的CDS手术正在常规进行，但该分析表明，老年患者并未接受许多潜在可治愈癌症的手术治疗。这些比率是否合适或过低需要进一步评估。鉴于我们的人口正在老龄化，这一点尤为重要。
