Department of Surgery, University of Texas Medical Branch, Galveston, Texas, USA.
J Am Geriatr Soc. 2011 Apr;59(4):647-54. doi: 10.1111/j.1532-5415.2011.03353.x. Epub 2011 Mar 31.
To evaluate time trends in surgical resection rates and operative mortality in older adults diagnosed with locoregional pancreatic cancer and to determine the effect of age on surgical resection rates and 2-year survival after surgical resection.
Retrospective cohort study using data from the Surveillance, Epidemiology, and End Results (SEER) and linked Medicare claims database (1992-2005).
Secondary data analysis of population-based tumor registry and linked claims data.
Medicare beneficiaries aged 66 and older diagnosed with locoregional pancreatic cancer (N=9,553), followed from date of diagnosis to time of death or censorship.
Percentage of participants undergoing surgical resection, 30-day operative mortality after resection, and 2-year survival according to age group.
Surgical resection rates increased significantly, from 20% in 1992 to 29% in 2005, whereas 30-day operative mortality rates decreased from 9% to 5%. After controlling for multiple factors, participants were less likely to be resected with older age. Resection was associated with lower hazard of death, regardless of age, with hazard ratios of 0.46, 0.51, 0.47, 0.43, and 0.35 for resected participants younger than 70, 70 to 74, 75 to 79, 80 to 84, and 85 and older respectively compared with unresected participants younger than 70 (P<.001).
With older age, fewer people with pancreatic cancer undergo surgical resection, even after controlling for comorbidity and other factors. This study demonstrated increased resection rates over time in all age groups, along with lower surgical mortality rates. Despite previous reports of greater morbidity and mortality after pancreatic resection in older adults, the benefit of resection does not diminish with older age in selected people.
评估老年局部区域性胰腺癌患者手术切除率和手术死亡率的时间趋势，并确定年龄对手术切除率和手术切除后 2 年生存率的影响。
利用监测、流行病学和最终结果（SEER）和相关医疗保险索赔数据库（1992-2005 年）的数据进行回顾性队列研究。
人群肿瘤登记处和相关索赔数据的二次数据分析。
年龄在 66 岁及以上、被诊断为局部区域性胰腺癌的医疗保险受益人（N=9553），从诊断日期开始随访至死亡或截止日期。
根据年龄组，接受手术切除的参与者比例、切除术后 30 天手术死亡率和 2 年生存率。
手术切除率显著增加，从 1992 年的 20%增加到 2005 年的 29%，而 30 天手术死亡率从 9%下降到 5%。在控制多种因素后，参与者的年龄越大，越不可能接受切除。无论年龄大小，切除与较低的死亡风险相关，与年龄小于 70 岁的未切除参与者相比，年龄小于 70 岁、70-74 岁、75-79 岁、80-84 岁和 85 岁及以上的切除参与者的死亡风险比分别为 0.46、0.51、0.47、0.43 和 0.35（P<.001）。
随着年龄的增长，接受胰腺癌手术切除的患者越来越少，即使在控制了合并症和其他因素后也是如此。本研究显示，所有年龄组的手术切除率随着时间的推移都有所增加，同时手术死亡率也有所下降。尽管之前有报道称老年患者胰腺切除术后发病率和死亡率更高，但在选定人群中，年龄增长不会降低切除的益处。
