Kiran Ravi Pokala, Pokala Naveen, Dudrick Stanley J
Department of Surgery, St. Mary's Hospital, Waterbury, Connecticut, USA.
Dis Colon Rectum. 2007 May;50(5):604-10. doi: 10.1007/s10350-006-0802-0.
Perceptions of poor outcome may detract caregivers from offering standard therapies to patients over 80 years who have been diagnosed with rectal cancer. We evaluate the effect of operative intervention on their survival.
Demographics, tumor characteristics, treatment, and survival for patients over 80 years with rectal and rectosigmoid cancer from 1993 to 2002 in the Surveillance, Epidemiology and End Results Program of the National Cancer Institute were examined. Survival was determined by using the Kaplan-Meier method. Patients who underwent operation (Group A) were compared with those who did not undergo surgery (Group B). Fisher's exact, chi-squared, analysis of variance, and log-rank tests were used as appropriate, and P < 0.05 was considered statistically significant.
A total of 9,501 patients (19 percent) were aged older than 80 years. Mean age was 85 years, and median survival was 24 months. Stage of disease was unknown for 2,915 patients. Median survival was 58, 53, 39, 27, and 5 months for Stages 0 (n=163), I (n=1,878), II (n=1,796), III (n=1,536), and IV (n=1,213), respectively. A total of 6,900 patients (81 percent) underwent surgery. Median survival for operated patients was significantly longer for all stages (36 vs. 5 months, P < 0.00001), Stage 0 (60 vs. 7 months, P < 0.01), Stage I (55 vs. 11 months, P < 0.0001), Stage II (41 vs. 13 months, P < 0.0001), Stage III (28 vs. 14 months, P < 0.05), and Stage IV (8 vs. 3 months, P < 0.0001). For patients with rectal cancer, local therapy also significantly improved median survival compared with nonoperated patients (P < 0.0001).
Operative intervention provides sustained benefit in terms of survival to patients aged >80 years with rectal cancer at all stages who are assessed to be a good operative risk. Age older than 80 years should not detract surgeons from offering optimal therapy to good-risk patients.
对不良预后的认知可能会使护理人员不愿为80岁以上被诊断为直肠癌的患者提供标准治疗。我们评估手术干预对其生存的影响。
研究了1993年至2002年美国国立癌症研究所监测、流行病学和最终结果计划中80岁以上直肠癌和直肠乙状结肠癌患者的人口统计学、肿瘤特征、治疗和生存情况。采用Kaplan-Meier方法确定生存率。将接受手术的患者（A组）与未接受手术的患者（B组）进行比较。根据情况使用Fisher精确检验、卡方检验、方差分析和对数秩检验，P<0.05被认为具有统计学意义。
共有共有共有共有9501名患者（19%）年龄超过80岁。平均年龄为85岁，中位生存期为24个月。2915名患者的疾病分期未知。0期（n=163）、I期（n=1878）、II期（n=1796）、III期（n=1536）和IV期（n=1213）患者的中位生存期分别为58、53、39、27和5个月。共有6900名患者（81%）接受了手术。所有分期接受手术患者的中位生存期均显著更长（36个月对5个月，P<0.00001），0期（60个月对7个月，P<0.01），I期（55个月对11个月，P<0.0001），II期（41个月对13个月，P<0.0001），III期（28个月对14个月，P<0.05），IV期（8个月对3个月，P<0.0001）。对于直肠癌患者，与未接受手术的患者相比，局部治疗也显著提高了中位生存期（P<0.0001）。
对于所有分期、被评估为手术风险低的80岁以上直肠癌患者，手术干预在生存方面提供了持续的益处。80岁以上不应阻碍外科医生为低风险患者提供最佳治疗。
