Sullivan Vita, Tran Tao, Holmstrom Amy, Kuskowski Michael, Koh Paul, Rubins Jeffrey B, Kelly Rosemary F
Division of Cardiovascular and Thoracic Surgery, University of Minnesota, Minneapolis, USA.
Chest. 2005 Oct;128(4):2671-6. doi: 10.1378/chest.128.4.2671.
Localized non-small cell lung carcinoma (NSCLC) is best treated by complete surgical resection, commonly requiring lobectomy. The impact of lobectomy on the health status of the elderly patient is not well-characterized. The aim of this study was to compare the effect of lobectomy in elderly patients (> or = 70 years of age) and younger patients (< 70 years of age) on their pulmonary function and functional status 1 year following surgery.
One hundred forty patients underwent lobectomy for NSCLC at the Minneapolis Veterans Affairs Medical Center from January 1999 to December 2003. All patients underwent pulmonary function tests (PFTs) and functional status assessment using Karnofsky scores (KS) that were assessed preoperatively. Sixty-three of 140 lobectomy patients were available 1 year postoperatively for reevaluation by PFTs and KS.
There was no statistical difference between groups in either the pulmonary function or functional status testing results at 1 year after undergoing lobectomy. FVC decreased by 14% in the elderly patient and by 9% in the younger patient group. FEV1 decreased by 19% in elderly patients and by 13% in younger patients. Functional status declined for two older patients (8%), who dropped their KS from 80 to 100% (normal activity without limitation) to 40 to 70% (unable to work, but able to care of self at home). Nine of the younger patients (24%) had KS drop from 80 to 100% to 40 to 70%. There was one perioperative death (30-day mortality rate for the study groups, 1.5%).
Elderly patients > or = 70 years of age undergoing lobectomy for NSCLC had similar PFT results and functional status as younger patients < 70 years of age 1 year after undergoing surgery. Curative resection should not be denied based on age alone.
局限性非小细胞肺癌（NSCLC）的最佳治疗方法是完整的手术切除，通常需要进行肺叶切除术。肺叶切除术对老年患者健康状况的影响尚未得到充分描述。本研究的目的是比较老年患者（≥70岁）和年轻患者（<70岁）肺叶切除术后1年对其肺功能和功能状态的影响。
1999年1月至2003年12月期间，140例患者在明尼阿波利斯退伍军人事务医疗中心接受了NSCLC肺叶切除术。所有患者均接受了术前肺功能测试（PFTs）和使用卡诺夫斯基评分（KS）进行的功能状态评估。140例肺叶切除患者中有63例在术后1年可通过PFTs和KS进行重新评估。
两组在肺叶切除术后1年的肺功能或功能状态测试结果上没有统计学差异。老年患者组的用力肺活量（FVC）下降了14%，年轻患者组下降了9%。老年患者的第一秒用力呼气容积（FEV1）下降了19%，年轻患者下降了13%。两名老年患者（8%）的功能状态下降，其KS评分从80至100%（正常活动无限制）降至40至70%（无法工作，但能在家自理）。9名年轻患者（24%）的KS评分从80至100%降至40至70%。围手术期死亡1例（研究组30天死亡率为1.5%）。
≥70岁的老年患者接受NSCLC肺叶切除术后1年的PFT结果和功能状态与<70岁的年轻患者相似。不应仅基于年龄而拒绝进行根治性切除。
