Aquina Christopher T, Mohile Supriya G, Tejani Mohamedtaki A, Becerra Adan Z, Xu Zhaomin, Hensley Bradley J, Arsalani-Zadeh Reza, Boscoe Francis P, Schymura Maria J, Noyes Katia, Monson John Rt, Fleming Fergal J
Surgical Health Outcomes and Research Enterprise (SHORE), Department of Surgery, University of Rochester Medical Center, Rochester, NY 14642, USA.
Division of Hematology/Oncology, Department of Medicine, University of Rochester Medical Center, Rochester, NY 14642, USA.
Br J Cancer. 2017 Jan;116(3):389-397. doi: 10.1038/bjc.2016.421. Epub 2017 Jan 5.
Given scarce data regarding the relationship among age, complications, and survival beyond the 30-day postoperative period for oncology patients in the United States, this study identified age-related differences in complications and the rate and cause of 1-year mortality following colon cancer surgery.
The NY State Cancer Registry and Statewide Planning and Research Cooperative System identified stage I-III colon cancer resections (2004-2011). Multivariable logistic regression and survival analyses assessed the relationship among age (<65, 65-74, ⩾75), complications, 1-year survival, and cause of death.
Among 24 426 patients surviving >30 days, 1-year mortality was 8.5%. Older age groups had higher complication rates, and older age and complications were independently associated with 1-year mortality (P<0.0001). Increasing age was associated with a decrease in the proportion of deaths from colon cancer with a concomitant increase in the proportion of deaths from cardiovascular disease. Older age and sepsis were independently associated with higher risk of colon cancer-specific death (65-74: HR=1.59, 95% CI=1.26-2.00; ⩾75: HR=2.57, 95% CI=2.09-3.16; sepsis: HR=2.58, 95% CI=2.13-3.11) and cardiovascular disease-specific death (65-74: HR=3.72, 95% CI=2.29-6.05; ⩾75: HR=7.02, 95% CI=4.44-11.10; sepsis: HR=2.33, 95% CI=1.81-2.99).
Older age and sepsis are associated with higher 1-year overall, cancer-specific, and cardiovascular-specific mortality, highlighting the importance of geriatric assessment, multidisciplinary care, and cardiovascular optimisation for older patients and those with infectious complications.
鉴于美国关于肿瘤患者术后30天以上的年龄、并发症和生存率之间关系的数据稀缺，本研究确定了结肠癌手术后并发症的年龄相关差异以及1年死亡率的发生率和原因。
纽约州癌症登记处和全州规划与研究合作系统确定了I - III期结肠癌切除术（2004 - 2011年）。多变量逻辑回归和生存分析评估了年龄（<65岁、65 - 74岁、⩾75岁）、并发症、1年生存率和死亡原因之间的关系。
在存活超过30天的24426例患者中，1年死亡率为8.5%。年龄较大的组并发症发生率较高，年龄较大和并发症与1年死亡率独立相关（P<0.0001）。年龄增加与结肠癌死亡比例下降相关，同时心血管疾病死亡比例增加。年龄较大和脓毒症与结肠癌特异性死亡风险较高独立相关（65 - 74岁：HR = 1.59，95%CI = 1.26 - 2.00；⩾75岁：HR = 2.57，95%CI = 2.09 - 3.16；脓毒症：HR = 2.58，95%CI = 2.13 - 3.11）以及心血管疾病特异性死亡风险较高独立相关（65 - 74岁：HR = 3.72，95%CI = 2.29 - 6.05；⩾75岁：HR = 7.02，95%CI = 4.44 - 11.10；脓毒症：HR = 2.33，95%CI = 1.81 - 2.99）。
年龄较大和脓毒症与1年总体、癌症特异性和心血管特异性死亡率较高相关，突出了老年评估、多学科护理以及对老年患者和有感染性并发症患者进行心血管优化的重要性。
