Fiorelli Alfonso, Vicidomini Giovanni, Mazzella Antonio, Messina Gaetana, Milione Roberta, Di Crescenzo Vincenzo Giuseppe, Santini Mario
Department of Thoracic Surgery, Second University of Naples, Naples, Italy.
Thoracic Surgery Unit, University of Salerno, Salerno, Italy.
Thorac Cardiovasc Surg. 2014 Oct;62(7):578-87. doi: 10.1055/s-0034-1373733. Epub 2014 Jun 24.
The aim of the study was to evaluate the influence of nutritional status on outcome of elderly patients resected for lung cancer.
A total of 117 consecutive patients aged ≥ 70 years undergoing lung cancer resection were enrolled. In addition to routine preoperative evaluations, other variables such as body mass index, weight loss, serum albumin, lymphocytes, and transferrin were counted. According to the body mass index value, patients were divided into Group A (≤ 18.5, underweight) and Group B (> 18.5) and risk factors for morbidity and mortality were analyzed.
Group A and Group B counted 21 and 96 patients, respectively. The mean age was 74.9 ± 2.6; body mass index of Group A was significantly lower than that of Group B (16.7 ± 1.3 vs. 23.5 ± 1.7, respectively, p < 0.0001). On multivariate analysis, significant risk factors for complications were pneumonectomy (p = 0.001), stage (p = 0.006), predictive postoperative flow expiratory volume in 1 second (ppoFEV1%) (p = 0.003), and coronary disease (p = 0.04) and significant risk factors for early mortality were pneumonectomy (p = 0.0002), ppoFEV1% (p < 0.0001), BMI (0.02), and weight loss (0.007). The median survival time of Group A and Group B was 41 versus 54 months, respectively (p = 0.1). However, body mass index of less than 18.5 (p = 0.01) and weight loss of > 5% before operation (p = 0.01) were independent risk factors for 1 year mortality.
In elderly patients, malnutrition was a significant additional risk factor for early death. Nutritional assessment should be included in the routine preoperative selection. In malnourished patients, nutritional support before and after operation and a careful postdischarge care might be beneficial, but it should be corroborated by further prospective studies.
本研究旨在评估营养状况对老年肺癌切除患者预后的影响。
共纳入117例年龄≥70岁的连续接受肺癌切除术的患者。除常规术前评估外，还计算了其他变量，如体重指数、体重减轻、血清白蛋白、淋巴细胞和转铁蛋白。根据体重指数值，将患者分为A组（≤ 18.5，体重过轻）和B组（> 18.5），并分析发病和死亡的危险因素。
A组和B组分别有21例和96例患者。平均年龄为74.９± 2.6岁；A组的体重指数显著低于B组（分别为16.7±1.3和23.5±1.7，p<0.0001）。多因素分析显示，并发症的显著危险因素为全肺切除术（p=0.001）、分期（p=0.006）、预测术后第1秒用力呼气量（ppoFEV1%）（p=0.003）和冠心病（p=0.04），早期死亡的显著危险因素为全肺切除术（p=0.0002）、ppoFEV1%（p<0.0001）、体重指数（0.02）和体重减轻（0.007）。A组和B组的中位生存时间分别为41个月和54个月（p=0.1）。然而，体重指数小于18.5（p=0.01）和术前体重减轻>5%（p=0.01）是1年死亡率的独立危险因素。
在老年患者中，营养不良是早期死亡的一个重要附加危险因素。营养评估应纳入常规术前筛选。在营养不良的患者中，术前和术后营养支持以及出院后仔细护理可能有益，但这需要进一步的前瞻性研究加以证实。
