老年胃癌患者手术治疗的安全性及生存获益
Safety and Survival Benefit of Surgical Management for Elderly Gastric Cancer Patients.
作者信息
Bi Yan-Mei, Chen Xin-Zu, Jing Cheng-Kun, Zhou Ru-Bai, Gaol Yu-Fei, Yang Li-Bo, Chen Xiao-Long, Yang Kun, Zhang Bo, Chen Zhi-Xin, Chen Jia-Ping, Zhou Zong-Guang, Hu Jian-Kun
出版信息
Hepatogastroenterology. 2014 May;61(131):853-7.
BACKGROUND/AIMS: To study the safety and survival outcome of surgical management for elderly gastric cancer patients.
METHODOLOGY
Patients proven of gastric cancer who aged 80 years during November 2002 to July 2011 were retrospectively analyzed. The detailed information of patients' characteristics and surgical management was retrieved. Follow-up of overall survival status was performed to analyze the surgical effectiveness.
RESULTS
Totally, 92 (48 in surgery and 44 in non-surgery group) out of 187 eligible patients recorded adequate information and analyzed finally. Median ages were 81 years in surgery group and 83 year in non-surgery group. There were 34 patients undergone radical gastrectomy, 6 palliative gastrectomy, 1 gastrojejunostomy and 7 exploratory laparotomy. Median follow-up durations were 25 (9-111) and 28 (8-114) months in surgery and non-surgery groups, respectively (p = 0.797). Clinical-pathological T stage was 6 T1, 5 T2, 14 T3 and 23 T4 cases for surgery and 7 T1, 6 T2, 3 T3, 7 T4 and 21 TX cases for non-surgery. Clinical-pathological node status was 18 N0, 7 N1, 6 N2, 7 N3 and 10 NX cases for surgery and 10 N0, 3 N1, 3 N2, 3 N3 and 25 NX cases for non-surgery. Clinical-pathological distal metastasis status was 15 and 26 M1 cases for surgery and non-surgery, respectively (p = 0.006). Incidence of postoperative complications was 25.0% and postoperative hospital mortality was 2.1%. The 2-year survival rates were 30.8% and 8.0% for surgery and none-surgery, respectively (HR = 3.023, p = 0.001), and the 3-year survival rates were 17.6% and 0% for surgery and non-surgery, respectively (HR = 3.680, p = 0.001). In M0 subgroup, 2-year survival rate was 35.7% and 0.0% for surgery and non-surgery groups, respectively (HR = 3.98, p = 0.022).
CONCLUSION
The safety of surgery for well-selected ≥ 80-year elderly gastric cancer patients was potentially acceptable and the patients of early or locally advanced diseases could obtain survival benefits by surgery.
背景/目的：研究老年胃癌患者手术治疗的安全性和生存结局。
方法
回顾性分析2002年11月至2011年7月期间年龄≥80岁的经证实为胃癌的患者。收集患者特征和手术治疗的详细信息。对总生存状况进行随访以分析手术效果。
结果
187例符合条件的患者中，共有92例（手术组48例，非手术组44例）记录了充分信息并最终进行分析。手术组的中位年龄为81岁，非手术组为83岁。有34例患者接受了根治性胃切除术，6例接受了姑息性胃切除术，1例接受了胃空肠吻合术，7例接受了剖腹探查术。手术组和非手术组的中位随访时间分别为25（9 - 111）个月和28（8 - 114）个月（p = 0.797）。手术组临床病理T分期为T1期6例、T2期5例、T3期14例、T4期23例；非手术组为T1期7例、T2期6例、T3期3例、T4期7例、TX期21例。手术组临床病理淋巴结状态为N0期18例、N1期7例、N2期6例、N3期7例、NX期10例；非手术组为N0期10例、N1期3例、N2期3例、N3期3例、NX期25例。手术组和非手术组临床病理远处转移状态分别为M1期15例和26例（p = 0.006）。术后并发症发生率为25.0%，术后医院死亡率为2.1%。手术组和非手术组的2年生存率分别为30.8%和8.0%（HR = 3.023，p = 0.001），3年生存率分别为17.6%和0%（HR = 3.680，p = 0.001）。在M0亚组中，手术组和非手术组的2年生存率分别为35.7%和0.0%（HR = 3.98，p = 0.022）。
结论
对于精心挑选的≥80岁老年胃癌患者而言，手术安全性可能是可接受的，早期或局部进展期疾病患者可通过手术获得生存益处。
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