Department of Thoracic Surgery, Haut Leveque Hospital, University of Bordeaux, France.
Eur J Cardiothorac Surg. 2011 Jun;39(6):981-6. doi: 10.1016/j.ejcts.2010.09.022. Epub 2010 Oct 27.
The elderly is a fast-growing segment of the population and the number of oncogeriatric patients with lung cancer is expected to increase. The purpose of this study was to overview surgical habits for lung cancer in octogenarians.
We used EPITHOR(®), the French national thoracic database, created in 2002 and including more than 135000 procedures from 93 institutions. We collected prospectively data concerning 622 patients 80 years or older, and 16461 patients younger than 80 years with lung cancer from 1 January 2004 to 31 December 2008. We compared patients' characteristics, lung-cancer presentation, and surgical treatment between these two groups.
Patients' characteristics analysis: the distribution by gender, body mass index, and forced expiratory volume was comparable for the two groups. American Society of Anesthesiologists (ASA) score (ASA 1 and 2: 59%, n=363 vs 71%, n=11543, p<0.0001) and performance status (PS) were worse for older patients (PS 0 and 1: 86%, n=470 vs 89%, n=12685, p<0.0001). Mean age (82.0, confidence interval (CI) 95% (81.9; 82.2)) and sex ratio (2.51, n=445 males) were stable for octogenarians across 5 years. Lung-cancer presentation analysis: in the elderly, stages I and II were of 71% (n=361) versus 66% (n=8735) in the younger group (p=0.001). Surgical treatment analysis: resections in octogenarians were pneumonectomy 10% (n=62) versus 15% (n=2409) for patients under 80 years, lobectomy 67% (n=415) versus 65% (n=10734), bilobectomy 4% (n=25) versus 5% (n=809), sub-lobar resection 11% (n=70) versus 8% (n=1355) (p=0.034). They underwent video-assisted thoracic surgery in 7% (n=43) versus 6% (n=917) (p=0.034). No lymph node dissection was more frequent in patients 80 years or older (8%, n=45) than in younger patients (5%, n=738) (p=0.0004).
Taken as a whole, octogenarians underwent more sub-lobar resections and less mediastinal lymph node dissections than younger patients. Effective management of lung cancer in older patients should be tailed to individual needs. Surgical treatment should not be denied on chronological age alone anymore.
老年人是人口中增长最快的群体，患有肺癌的老年肿瘤患者人数预计将会增加。本研究旨在概述 80 岁以上肺癌患者的手术习惯。
我们使用了 EPITHOR（®），这是一个法国国家胸科数据库，创建于 2002 年，包含了 93 家机构的 135000 多例手术。我们前瞻性地收集了 2004 年 1 月 1 日至 2008 年 12 月 31 日期间，80 岁及以上的 622 例和 80 岁以下的 16461 例肺癌患者的数据。我们比较了这两组患者的特征、肺癌表现和手术治疗情况。
患者特征分析：两组患者的性别、体重指数和用力呼气量分布相似。美国麻醉医师协会（ASA）评分（ASA 1 和 2：59%，n=363 与 71%，n=11543，p<0.0001）和表现状态（PS）评分更差（PS 0 和 1：86%，n=470 与 89%，n=12685，p<0.0001）。80 岁以上患者的平均年龄（82.0，95%置信区间（CI）为 81.9；82.2）和性别比（2.51，n=445 名男性）在 5 年内保持稳定。肺癌表现分析：在老年人中，I 期和 II 期为 71%（n=361），而年轻组为 66%（n=8735）（p=0.001）。手术治疗分析：80 岁以上患者的肺切除术为 10%（n=62），而 80 岁以下患者为 15%（n=2409）；肺叶切除术为 67%（n=415），而 65%（n=10734）；双肺叶切除术为 4%（n=25），而 5%（n=809）；亚肺叶切除术为 11%（n=70），而 8%（n=1355）（p=0.034）。他们接受电视辅助胸腔镜手术的比例为 7%（n=43），而 6%（n=917）（p=0.034）。80 岁以上患者的纵隔淋巴结清扫术少于年轻患者（8%，n=45 与 5%，n=738）（p=0.0004）。
总体而言，80 岁以上患者比年轻患者接受更多的亚肺叶切除术和较少的纵隔淋巴结清扫术。应该根据个体需求来有效地管理老年患者的肺癌。不应该仅仅根据年龄来拒绝手术治疗。
