80 岁及以上老年结肠癌患者的外科治疗：SEER-Medicare 数据库中 31574 例患者的分析。
Surgical treatment of colon cancer in patients aged 80 years and older : analysis of 31,574 patients in the SEER-Medicare database.
机构信息
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792-7375, USA.
出版信息
Cancer. 2013 Feb 1;119(3):639-47. doi: 10.1002/cncr.27765. Epub 2012 Aug 14.
BACKGROUND
Age-related disparities in colon cancer treatment exist, with older patients being less likely to receive recommended therapy. However, to the authors' knowledge, few studies to date have focused on receipt of surgery. The objective of the current study was to describe patterns of surgery in patients aged ≥ 80 years with colon cancer and examine outcomes with and without colectomy.
METHODS
Medicare beneficiaries aged ≥ 80 years with colon cancer who were diagnosed between 1992 and 2005 were identified from the Surveillance, Epidemiology, and End Results-Medicare database. Multivariable logistic regression analysis was used to assess factors associated with nonoperative management. Kaplan-Meier survival analysis determined 1-year overall and colon cancer-specific survival.
RESULTS
Of 31,574 patients, 80% underwent colectomy. Approximately 46% were diagnosed during an urgent/emergent hospital admission, with decreased 1-year overall survival (70% vs 86% for patients diagnosed during an elective admission) noted among these individuals. Factors found to be most predictive of nonoperative management included older age, black race, more hospital admissions, use of home oxygen, use of a wheelchair, being frail, and having dementia. For both operative and nonoperative patients, the 1-year overall survival rate was lower than the colon cancer-specific survival rate (operative patients: 78% vs 89%; nonoperative patients: 58% vs 78%).
CONCLUSIONS
The majority of older patients with colon cancer undergo surgery, with improved outcomes noted compared with nonoperative management. However, many patients who are not selected for surgery die of unrelated causes, reflecting good surgical selection. Patients undergoing surgery during an urgent/emergent admission have an increased short-term mortality risk. Because the earlier detection of colon cancer may increase the percentage of older patients undergoing elective surgery, the findings of the current study may have policy implications for colon cancer screening and suggest that age should not be the only factor driving cancer screening recommendations.
背景
结肠癌的治疗存在与年龄相关的差异，老年患者接受推荐治疗的可能性较低。然而，据作者所知，迄今为止，很少有研究关注手术的接受情况。本研究的目的是描述 80 岁以上结肠癌患者手术的模式，并检查有无结肠切除术的治疗结果。
方法
从监测、流行病学和最终结果-医疗保险数据库中确定了 1992 年至 2005 年间诊断为 80 岁以上的结肠癌医疗保险受益人的数据。多变量逻辑回归分析用于评估与非手术治疗相关的因素。Kaplan-Meier 生存分析确定了 1 年的总体生存率和结肠癌特异性生存率。
结果
在 31574 名患者中，80%接受了结肠切除术。大约 46%的患者是在紧急/紧急住院期间被诊断出来的，这些患者的 1 年总体生存率较低（与在择期入院时诊断的患者相比，分别为 70%和 86%）。发现最能预测非手术治疗的因素包括年龄较大、黑种人、更多的住院、使用家庭吸氧、使用轮椅、身体虚弱和患有痴呆症。对于手术和非手术患者，1 年的总体生存率均低于结肠癌特异性生存率（手术患者：78%比 89%；非手术患者：58%比 78%）。
结论
大多数患有结肠癌的老年患者接受手术治疗，与非手术治疗相比，手术治疗的预后更好。然而，许多未接受手术治疗的患者死于无关原因，这反映了良好的手术选择。在紧急/紧急入院期间接受手术的患者短期死亡率风险增加。由于结肠癌的早期检测可能会增加接受择期手术的老年患者的比例，因此本研究的结果可能对结肠癌筛查政策有影响，并表明年龄不应是推动癌症筛查建议的唯一因素。
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