Choi Ju Young, Shim Ki-Nam, Roh Sun Hee, Tae Chung Hyun, Kim Seong-Eun, Jung Hye-Kyung, Kim Tae-Hun, Jung Sung-Ae, Yoo Kwon, Moon Il Whan
Department of Internal Medicine, Ewha Medical Research Institute, Ewha Womans University School of Medicine, Seoul, Korea.
Korean J Gastroenterol. 2011 Jul;58(1):9-19. doi: 10.4166/kjg.2011.58.1.9.
BACKGROUND/AIMS: It has been known that elderly patients with gastric cancer show worse general condition and higher comorbidities. Therefore, few elderly patients undergo surgery. This study was designed to determine clinicopathological characteristics of gastric cancer in elderly patients and evaluate their survival improvements by the surgical treatment.
Gastric cancer patients, diagnosed at Ewha Womans University Mokdong Hospital between 2000 to 2004, were divided into two groups those aged ≥65 years vs. <65 years. Clinicopathological characteristics, incidence of postoperative complications, and survival time of patients in each group were analyzed.
Total 370 patients were subjected and divided into the elderly and the younger group (55.4% vs. 44.6%). The elderly group showed higher incidences of hypertension and cardiovascular disease. Well differentiated adenocarcinoma was more frequently found in the elderly group (19.0% vs. 10.0%, p=0.025). There were no differences of operation time (242.6±70.7 vs. 257.3±83.8 min, p=0.115), postoperative hospital stays (15.8±10.6 vs. 14.7±9.8 days, p=0.361), and incidence of any complications (6.7% vs. 9.9%, p=0.309) between the two subgroups. The significant factors related with the elderly patient's survival were the tumor-node-metastasis (TNM) stage (stage I, hazard ratio [HR] 1.00; stage II, HR 1.28, 95% confidence interval [CI] 0.44-3.72; stage III, HR 4.06, 95% CI 2.08-7.92, stage IV, HR 9.78, 95% CI 4.97-19.26; p<0.001) and the treatment modality (laparoscopy, HR 1.00; open surgery, HR 3.90, 95% CI 2.43-6.26; p<0.001). The elderly patients who underwent gastric cancer surgery showed prolonged survival on TNM stage I, II, and III than those who were treated conservatively.
In the elderly patients with gastric cancer, those who had received surgical treatments showed significantly higher survival rate than those who had treated conservatively. Therefore, aggressive surgical treatments should be seriously considered even for the elderly patients with gastric cancer.
背景/目的：已知老年胃癌患者一般状况较差且合并症较多。因此，接受手术的老年患者较少。本研究旨在确定老年胃癌患者的临床病理特征，并评估手术治疗对其生存改善情况。
对2000年至2004年在梨花女子大学木洞医院诊断为胃癌的患者分为两组，年龄≥65岁组和＜65岁组。分析每组患者的临床病理特征、术后并发症发生率及生存时间。
共纳入370例患者，分为老年组和年轻组（55.4%对44.6%）。老年组高血压和心血管疾病发生率较高。高分化腺癌在老年组更常见（19.0%对10.0%，p = 0.025）。两组亚组间手术时间（242.6±70.7对257.3±83.8分钟，p = 0.115）、术后住院时间（15.8±10.6对14.7±9.8天，p = 0.361）及任何并发症发生率（6.7%对9.9%，p = 0.309）无差异。与老年患者生存相关的显著因素为肿瘤-淋巴结-转移（TNM）分期（I期，风险比[HR] 1.00；II期，HR 1.28，95%置信区间[CI] 0.44 - 3.72；III期，HR 4.06，95% CI 2.08 - 7.92，IV期，HR 9.78，95% CI 4.97 - 19.26；p＜0.001）和治疗方式（腹腔镜手术，HR 1.00；开放手术，HR 3.90，95% CI 2.43 - 6.26；p＜0.001）。接受胃癌手术的老年患者在TNM I、II和III期的生存期比保守治疗的患者延长。
在老年胃癌患者中，接受手术治疗的患者生存率显著高于保守治疗的患者。因此，即使是老年胃癌患者也应认真考虑积极的手术治疗。
