老年女性乳腺癌患者手术治疗前后的健康措施和并发症。

Pretreatment health measures and complications after surgical management of elderly women with breast cancer.

机构信息

School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK; Manchester Academic Health Sciences Centre, Core Technology Facility, Manchester, UK.

出版信息

Br J Surg. 2015 May;102(6):653-67. doi: 10.1002/bjs.9796. Epub 2015 Mar 18.

DOI:10.1002/bjs.9796

PMID:25790147

Abstract

BACKGROUND

Elderly patients with breast cancer are less likely to be offered surgery, partly owing to co-morbidities and reduced functional ability. However, there is little consensus on how best to assess surgical risk in this patient group.

METHODS

The ability of pretreatment health measures to predict complications was investigated in a prospective cohort study of a consecutive series of women aged at least 70 years undergoing surgery for operable (stage I-IIIa) breast cancer at 22 English breast units between 2010 and 2013. Data on treatment, surgical complications, health measures and tumour characteristics were collected by case-note review and/or patient interview. Outcome measures were all complications and serious complications within 30 days of surgery.

RESULTS

The study included 664 women. One or more complications were experienced by 41·0 per cent of the patients, predominantly seroma or primary/minor infections. Complications were serious in 6·5 per cent. More extensive surgery predicted a higher number of complications, but not serious complications. Older age did not predict complications. Several health measures were associated with complications in univariable analysis, and were included in multivariable analyses, adjusting for type/extent of surgery and tumour characteristics. In the final models, pain predicted a higher count of complications (incidence rate ratio 1·01, 95 per cent c.i. 1·00 to 1·01; P = 0·004). Fatigue (odds ratio (OR) 1·02, 95 per cent c.i. 1·01 to 1·03; P = 0·004), low platelet count (OR 4·19, 1·03 to 17·12: P = 0·046) and pulse rate (OR 0·96, 0·93 to 0·99; P = 0·010) predicted serious complications.

CONCLUSION

The risk of serious complications from breast surgery is low for older patients. Surgical decisions should be based on patient fitness rather than age. Health measures that predict surgical risk were identified in multivariable models, but the effects were weak, with 95 per cent c.i. close to unity.

摘要

背景

老年乳腺癌患者接受手术的可能性较低，部分原因是合并症和功能能力下降。然而，对于如何最好地评估这一患者群体的手术风险，目前尚无共识。

方法

本前瞻性队列研究纳入了 2010 年至 2013 年期间在 22 家英国乳腺癌中心接受手术治疗的至少 70 岁、可手术（I-IIIa 期）乳腺癌连续患者，评估了术前健康指标预测并发症的能力。通过病历回顾和/或患者访谈收集了治疗、手术并发症、健康指标和肿瘤特征的数据。主要结局为术后 30 天内所有并发症和严重并发症。

结果

本研究纳入了 664 名女性患者。41.0%的患者发生了 1 种或多种并发症，主要为血清肿或原发性/轻度感染。6.5%的患者发生了严重并发症。手术范围越广泛，预测并发症的数量越多，但不能预测严重并发症。年龄较大与并发症无关。多项健康指标在单变量分析中与并发症相关，并纳入多变量分析，调整了手术类型/范围和肿瘤特征。在最终模型中，疼痛预测并发症数量更高（发病率比 1.01，95%置信区间 1.00 至 1.01；P=0.004）。疲劳（比值比 1.02，95%置信区间 1.01 至 1.03；P=0.004）、血小板计数低（比值比 4.19，1.03 至 17.12：P=0.046）和脉搏率（比值比 0.96，0.93 至 0.99；P=0.010）预测严重并发症。