Fujiwara Yoshinori, Fukuda Shuichi, Tsujie Masanori, Ishikawa Hajime, Kitani Kotaro, Inoue Keisuke, Yukawa Masao, Inoue Masatoshi
Yoshinori Fujiwara, Shuichi Fukuda, Masanori Tsujie, Hajime Ishikawa, Kotaro Kitani, Keisuke Inoue, Masao Yukawa, Masatoshi Inoue, Department of Digestive Surgery, Nara Hospital, Kindai University School of Medicine, Ikoma, Nara 630-0293, Japan.
World J Gastrointest Oncol. 2017 Jun 15;9(6):257-262. doi: 10.4251/wjgo.v9.i6.257.
To evaluate clinicopathological features and surgical outcomes of gastric cancer in elderly and non-elderly patients after inverse probability of treatment weighting (IPTW) method using propensity score.
We enrolled a total of 448 patients with histologically confirmed primary gastric carcinoma who received gastrectomies. Of these, 115 patients were aged > 80 years old (Group A), and 333 patients were aged < 79 years old (Group B). We compared the surgical outcomes and survival of the two groups after IPTW.
Postoperative complications, especially respiratory complications and hospital deaths, were significantly more common in Group A than in Group B ( < 0.05). Overall survival (OS) was significantly lower in Group A patients than in Group B patients. Among the subset of patients who had pathological Stage I disease, OS was significantly lower in Group A ( < 0.05) than Group B, whereas cause-specific survival was almost equal in the two groups. In multivariate analysis, pathological stage, histology, and extent of lymph node dissection were independent prognostic values for OS.
When the gastrectomy was performed in gastric cancer patients, we should recognized high mortality and comorbidities in that of elderly. More extensive lymph node dissection might improve prognoses of elderly gastric cancer patients.
采用倾向评分的逆概率加权法（IPTW）评估老年和非老年胃癌患者的临床病理特征及手术结果。
我们共纳入448例经组织学确诊的原发性胃癌且接受了胃切除术的患者。其中，115例患者年龄>80岁（A组），333例患者年龄<79岁（B组）。我们比较了IPTW后两组的手术结果和生存率。
术后并发症，尤其是呼吸并发症和医院死亡，A组比B组明显更常见（<0.05）。A组患者的总生存期（OS）明显低于B组患者。在病理分期为I期的患者亚组中，A组的OS明显低于B组（<0.05），而两组的病因特异性生存率几乎相等。多因素分析中，病理分期、组织学类型和淋巴结清扫范围是OS的独立预后因素。
对胃癌患者实施胃切除术时，我们应认识到老年患者的高死亡率和高合并症发生率。更广泛的淋巴结清扫可能改善老年胃癌患者的预后。
