Department of Surgery, South Miyagi Medical Center, Oogawara, Japan.
J Surg Oncol. 2014 May;109(6):586-92. doi: 10.1002/jso.23542. Epub 2013 Dec 27.
The long-term prognosis of elderly gastric cancer patients is poor because of the cancer and unrelated comorbidities. We investigated the risk factors for mortality after gastrectomy to aid surgeons in deciding the correct operative procedure for elderly gastric cancer patients.
A total of 414 gastric cancer patients surgically treated between 2002 and 2012 were divided into two groups A (≥75 years) and B (<75 years). Data were collected retrospectively and analyzed using the Estimation of Physiological Ability and Surgical Stress (E-PASS) scoring system as a predictor of postoperative complications.
Overall survival (P < 0.001), disease-specific survival (P = 0.029), and survival rate related to comorbid disease (P < 0.001) were significantly reduced in elderly patients compared with younger patients. Surgical treatment for Group A involved lesser extent of nodal resection (P < 0.001). Multivariate analysis revealed that a comprehensive risk score (CRS) ≥0.5 based on the E-PASS score (P = 0.022) and severe postoperative complication (P = 0.002) were independent risk factors for mortality from comorbid disease.
Thus, E-PASS-based CRS was a good predictor of comorbidity-related mortality. CRS may help surgeons select elderly patients with gastric cancer for surgical or other therapies.
由于癌症和无关的合并症，老年胃癌患者的长期预后较差。我们研究了胃切除术后死亡的危险因素，以帮助外科医生为老年胃癌患者选择正确的手术方法。
回顾性收集了 2002 年至 2012 年间接受手术治疗的 414 例胃癌患者的资料，将其分为 A 组（≥75 岁）和 B 组（<75 岁）。使用生理能力和手术应激估计（E-PASS）评分系统作为术后并发症的预测指标，收集数据并进行分析。
与年轻患者相比，老年患者的总体生存率（P<0.001）、疾病特异性生存率（P=0.029）和与合并症相关的生存率（P<0.001）显著降低。A 组的手术治疗涉及的淋巴结切除范围较小（P<0.001）。多因素分析显示，E-PASS 评分（P=0.022）和严重术后并发症（P=0.002）的综合风险评分（CRS）≥0.5 是与合并症相关的死亡的独立危险因素。
因此，基于 E-PASS 的 CRS 是合并症相关死亡率的良好预测指标。CRS 可能有助于外科医生为患有胃癌的老年患者选择手术或其他治疗方法。
