Yano Tokujiro, Shimokawa Mototsugu, Kawashima Osamu, Takenoyama Mitsuhiro, Yamashita Yoshinori, Fukami Takeshi, Ueno Tsuyoshi, Yatsuyanagi Eiji, Fukuyama Seiichi
Department of General Thoracic Surgery, National Hospital Organization Beppu Medical Center, 1473 Uchikamado, Beppu, 874-0011, Japan.
Cancer Biostatistics Laboratory, Clinical Research Institute, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan.
Gen Thorac Cardiovasc Surg. 2018 Jun;66(6):344-350. doi: 10.1007/s11748-018-0919-9. Epub 2018 Apr 3.
We conducted a multi-institutional prospective observational study of elderly patients (≥ 75 years-old) with resected non-small cell lung cancer. In this report, we have followed the cohorts for 2 years after surgery and examined both the influence of preoperative comorbidity [Adult Comorbidity Evaluation-27 (ACE-27) index] on the postoperative survival and the change in the Karnofsky Performance Status (KPS).
From March 2014 to April 2015, 264 patients were prospectively registered from 22 hospitals affiliated with the National Hospital Organization. The mean age at the time of surgery was 79.3 years (range 75-90 years), and 41% of the patients were ≥ 80 years of age. A total of 26% underwent sublobar resection. The study endpoints were the postoperative overall survival (OS), its prognostic factors, and the changes in the postoperative KPS.
The 2-year OS was 85.3% (95% confidence interval 80.4-89.1%). Male gender, age ≥ 80, a smoking history, grade 2 of ACE-27, and an advanced disease stage were significantly poor prognostic factors for the OS in the univariate risk analysis. The multivariate analysis showed that male gender, age ≥ 80, an advanced disease stage and sublobar resection were significantly poor prognostic factors for the OS. In comparison with the preoperative KPS, no marked decline was observed in the postoperative chorological change of KPS.
In the surgical treatment of elderly patients, the comorbidity as assessed by the ACE-27 index might affect the postoperative survival, and therefore should be taken into accounts in the preoperative evaluation of the surgical indications.
我们对接受非小细胞肺癌切除术的老年患者（≥75岁）进行了一项多机构前瞻性观察研究。在本报告中，我们对这些队列进行了术后2年的随访，并研究了术前合并症[成人合并症评估-27（ACE-27）指数]对术后生存的影响以及卡氏功能状态（KPS）的变化。
2014年3月至2015年4月，从国立医院组织下属的22家医院前瞻性登记了264例患者。手术时的平均年龄为79.3岁（范围75-90岁），41%的患者年龄≥80岁。共有26%的患者接受了肺叶下切除术。研究终点为术后总生存期（OS）、其预后因素以及术后KPS的变化。
2年总生存率为85.3%（95%置信区间80.4-89.1%）。在单因素风险分析中，男性、年龄≥80岁、吸烟史、ACE-27评分为2级以及疾病晚期是总生存期显著不良的预后因素。多因素分析显示，男性、年龄≥80岁、疾病晚期和肺叶下切除术是总生存期显著不良的预后因素。与术前KPS相比，术后KPS的变化未观察到明显下降。
在老年患者的外科治疗中，ACE-27指数评估的合并症可能影响术后生存，因此在手术适应症的术前评估中应予以考虑。
