Leo Francesco, Scanagatta Paolo, Baglio Pierangelo, Radice Davide, Veronesi Giulia, Solli Piergiorgio, Petrella Francesco, Spaggiari Lorenzo
Thoracic Surgery Department, European Institute of Oncology, Milan, Italy.
Eur J Cardiothorac Surg. 2007 May;31(5):780-2. doi: 10.1016/j.ejcts.2007.01.036. Epub 2007 Feb 22.
A higher mortality has been reported after pneumonectomy over the age of 70. The aim of the study was to quantify the additional risk due to age after standard pneumonectomy for lung cancer by a case-control study.
Our clinical database was reviewed to search for patients aged 70 years or more who underwent standard pneumonectomy for lung cancer between 1998 and 2005. A control group of patients younger than 70 (one case/two controls) was matched for sex, cardiovascular disease, American Association of Anaesthetists score, respiratory function, side of pneumonectomy, induction chemotherapy and stage. Overall mortality and morbidity were compared. Long-term survival data were also analysed.
During the considered period, 35 patients aged 70 years or more underwent pneumonectomy (30 males, median age 73 years, 15 right-sided procedures). The control group was composed of 70 patients. The two groups were homogeneous in the variables used for matching. Overall mortality and morbidity were 11.4 and 54.2% in the elderly group as compared to 4.3 and 41.6% in controls (p-value not significant). Elderly patients experienced a higher rate of respiratory complications (25.7%) as compared to controls (8.3%, p=0.01). At univariate analysis, the only risk factor for death was the occurrence of respiratory complications (OR 6.5, CI 1.8-18.2). At multivariate analysis, age >or=70 years (OR 5.36, CI 1.48-19.3) and preoperative chemotherapy (OR 7.65, CI 2.04-28.6) were confirmed as predictors of respiratory complications. Five-year survival was 17.5% in the elderly group and 53.6% in the control group (p=0.003). Elderly patients with a better respiratory function (FEV1>70%) had a 5-year survival of 45.4%.
In the elderly patients, the risk of respiratory complications after pneumonectomy is increased as compared to younger patients with equivalent respiratory function. Age and preoperative chemotherapy are independent risk factors for respiratory complications. A lower mortality and a better long-term survival are obtained in elderly patients with a better respiratory function (FEV1>or=70%).
据报道，70岁以上患者肺切除术后死亡率更高。本研究旨在通过病例对照研究量化肺癌标准肺切除术后因年龄导致的额外风险。
回顾我们的临床数据库，以寻找1998年至2005年间接受肺癌标准肺切除术的70岁及以上患者。选择年龄小于70岁的患者作为对照组（1例患者/2名对照），并根据性别、心血管疾病、美国麻醉医师协会评分、呼吸功能、肺切除侧别、诱导化疗和分期进行匹配。比较总体死亡率和发病率。还分析了长期生存数据。
在研究期间，35例70岁及以上患者接受了肺切除术（30例男性，中位年龄73岁，15例右侧手术）。对照组由70例患者组成。两组在用于匹配的变量方面具有同质性。老年组的总体死亡率和发病率分别为11.4%和54.2%，而对照组分别为4.3%和41.6%（p值无统计学意义）。与对照组（8.3%，p = 0.01）相比，老年患者发生呼吸并发症的比率更高（25.7%）。单因素分析显示，死亡的唯一危险因素是呼吸并发症的发生（比值比6.5，可信区间1.8 - 18.2）。多因素分析显示，年龄≥70岁（比值比5.36，可信区间1.48 - 19.3）和术前化疗（比值比7.65，可信区间2.04 - 28.6）被确认为呼吸并发症的预测因素。老年组的5年生存率为17.5%，对照组为53.6%（p = 0.003）。呼吸功能较好（第1秒用力呼气容积>70%）的老年患者5年生存率为45.4%。
与呼吸功能相当的年轻患者相比，老年患者肺切除术后发生呼吸并发症的风险增加。年龄和术前化疗是呼吸并发症的独立危险因素。呼吸功能较好（第1秒用力呼气容积≥70%）的老年患者死亡率较低，长期生存率较高。
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