Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Honmachi 68, Himeji-City, Hyogo, 670-8520, Japan.
World J Surg. 2018 Jan;42(1):153-160. doi: 10.1007/s00268-017-4142-0.
Although the frequency of elderly patients undergoing surgery for lung cancer has been increasing, indications for surgery in elderly patients are still controversial. Low body mass index is a significant predictor of poor prognosis in elderly patients with various medical conditions. Then, we examined the long-term outcome of elderly patients who had undergone thoracic surgery for lung cancer, focusing especially on body mass index.
Between January 2004 and March 2011, 1673 patients with lung cancer underwent surgical resection at our institution. Among these patients, we retrospectively examined 158 patients aged 80 years or older.
Perioperative morbidity and mortality rates were 41.8 and 1.3%, respectively. Among 149 patients who were completely followed up, 80 patients (53.7%) died. The overall postoperative survival rates at 3 and 5 years were 66.9 and 49.9%, respectively. Univariate analysis demonstrated that sex (female), smoking index (pack-years <20), histology (non-squamous cell carcinoma), pathological stage (stage I) and BMI (within normal BMI) were statistically significant factors associated with better outcome. Multivariate analysis revealed that patients with a low (<18.5 kg/m) or high (≥25 kg/m) body mass index had a significantly and poorer prognosis than patients with a normal body mass index.
Body mass index is a more useful prognostic factor than other clinical factors including pathological stage in elderly patients. Because elderly patients with low and high body mass index have a significant poor prognosis, surgeons and pulmonologist should take this into account when consider surgical indication for such elderly patients.
尽管接受肺癌手术的老年患者的频率有所增加，但老年患者的手术适应证仍存在争议。低体重指数是各种医疗条件下老年患者预后不良的重要预测指标。然后，我们检查了接受胸部手术治疗肺癌的老年患者的长期结果，特别关注体重指数。
2004 年 1 月至 2011 年 3 月，我院 1673 例肺癌患者接受手术切除。在这些患者中，我们回顾性检查了 158 例 80 岁或以上的患者。
围手术期发病率和死亡率分别为 41.8%和 1.3%。在 149 例完全随访的患者中，80 例（53.7%）死亡。术后 3 年和 5 年的总生存率分别为 66.9%和 49.9%。单因素分析表明，性别（女性）、吸烟指数（<20 包年）、组织学（非鳞状细胞癌）、病理分期（Ⅰ期）和 BMI（正常 BMI 范围内）是与更好预后相关的统计学显著因素。多因素分析显示，体重指数低（<18.5kg/m）或高（≥25kg/m）的患者比体重指数正常的患者预后明显更差。
体重指数是比包括病理分期在内的其他临床因素更有用的预后因素。由于低体重指数和高体重指数的老年患者预后明显较差，外科医生和肺病学家在考虑此类老年患者的手术适应证时应考虑到这一点。
