Yano Tokujiro, Kawashima Osamu, Takeo Sadanori, Adachi Hirofumi, Tagawa Tsutomu, Fukuyama Seiichi, Shimokawa Mototsugu
Department of General Thoracic Surgery, National Hospital Organization Beppu Medical Center, Beppu, Japan.
Department of Chest Surgery, National Hospital Organization Shibukawa Medical Center, Shibukawa, Japan.
Semin Thorac Cardiovasc Surg. 2017 Winter;29(4):540-547. doi: 10.1053/j.semtcvs.2017.05.004. Epub 2017 May 26.
The operative morbidity rate in elderly patients with lung cancer is high in comparison to nonelderly patients, probably because of the increase in comorbidities that occurs with aging. However, previous reports were retrospective and were performed at single institutions; thus, the preoperative comorbidities and operative morbidity could not be fully assessed. We conducted a multi-institutional prospective observational study of elderly patients (>75 years of age) with a completely resected non-small cell lung cancer. From March 2014 to April 2015, 264 patients from 22 hospitals affiliated with the National Hospital Organization in Japan were prospectively registered in the present study. The primary end point was operative morbidity (National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0). The secondary end points were operative mortality and the risk factors for operative morbidity. Preoperative comorbidities were assessed according to the Adult Comorbidity Evaluation-27 index. The mean age at the time of surgery was 79.3 years (range 75-90 years). Forty-one percent of the patients were >80 years of age. Twenty-six percent underwent sublobar resection. The incidence of morbidities of any grade was 43.2% (90% confidence interval: 38.2%-48.2%). Respiratory system-related morbidity (19.3%), followed by cardiovascular system-related morbidity (10.2%), was the most common morbidity. The in-hospital mortality rate was 1.1% (3 of 264 patients). A multivariate analysis of the risk factors for operative morbidity showed that both Adult Comorbidity Evaluation-27 grade and the blood loss volume were significant factors. The results of the present prospective multi-institutional study should be used as a reference in the surgical treatment of elderly patients with lung cancer.
与非老年患者相比，老年肺癌患者的手术并发症发生率较高，这可能是由于随着年龄增长合并症增多所致。然而，既往报告多为回顾性研究且在单一机构开展；因此，术前合并症和手术并发症无法得到全面评估。我们对年龄＞75岁、非小细胞肺癌完全切除的老年患者进行了一项多机构前瞻性观察性研究。2014年3月至2015年4月，来自日本国立医院机构下属22家医院的264例患者前瞻性纳入本研究。主要终点为手术并发症（美国国立癌症研究所不良事件通用术语标准第4.0版）。次要终点为手术死亡率和手术并发症的危险因素。根据成人合并症评估-27指数评估术前合并症。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。26%的患者接受了肺叶以下切除。任何级别的并发症发生率为43.2%（90%置信区间：38.2% - 48.2%）。最常见的并发症是呼吸系统相关并发症（19.3%），其次是心血管系统相关并发症（10.2%）。住院死亡率为1.1%（264例患者中有3例）。手术并发症危险因素的多因素分析显示，成人合并症评估-27分级和失血量均为显著因素。本项前瞻性多机构研究结果应用于老年肺癌患者手术治疗的参考。
