Miura Naoko, Shoji Fumihiro, Kozuma Yuka, Toyokawa Gouji, Yamazaki Koji, Takeo Sadanori
Department of Thoracic Surgery, Clinical Research Institute, National Hospital Organization, Kyushu Medical Center, Fukuoka, Fukuoka, Japan.
Department of Thoracic Oncology, National Hospital Organization, National Kyushu Cancer Center, Fukuoka, Fukuoka, Japan.
Ann Thorac Cardiovasc Surg. 2020 Oct 21;26(5):240-247. doi: 10.5761/atcs.oa.19-00207. Epub 2020 Jan 29.
Elderly non-small-cell lung cancer (NSCLC) patients are increasing. In general, elderly patients often have more comorbidities and worse immune-nutritional condition.
In total, 122 NSCLC patients aged 75 years or older, underwent thoracic surgery between January 2007 and December 2010. In all, 99 of 122 patients (81.1%) who had preoperative comorbidities were retrospectively analyzed. We evaluated the preoperative immune-nutritional condition using the controlling nutritional status (CONUT) score.
We decided the best cutoff value for CONUT score was 1; as a result, 42 of 99 patients (42.4%) had abnormal preoperative CONUT score. Univariate analyses showed sex (P = 0.0099), smoking status (P = 0.0176), pathological stage (P = 0.0095), and preoperative CONUT score (P = 0.0175) significantly affected overall survival (OS). In multivariate analysis, pathological stage (relative risk (RR): 2.12; 95% confidence interval (CI): 1.10-3.90; P = 0.0268) and preoperative CONUT score (RR: 2.10; 95% CI: 1.20-3.67; P = 0.0094) were shown to be independent prognostic factors. In Kaplan-Meier analysis of OS, the preoperative abnormal CONUT score group had significantly shorter OS than did the preoperative normal CONUT score group (P = 0.0152, log-rank test); however, there were no statistical differences both in disease-free survival (DFS) and cancer-specific survival (CSS; P = 0.9238 and P = 0.8661, log-rank test, respectively). In total, 22 patients (46.8%) were dead caused by other diseases such as pneumonia or other organs malignancies.
Preoperative abnormal CONUT score is a poor prognostic factor for the elderly NSCLC patients with preoperative comorbidities and might predict poor postoperative outcome caused by not primary lung cancer but other diseases.
老年非小细胞肺癌（NSCLC）患者数量正在增加。总体而言，老年患者通常合并症更多，免疫营养状况更差。
2007年1月至2010年12月期间，共有122例75岁及以上的NSCLC患者接受了胸外科手术。对122例患者中99例（81.1%）术前有合并症的患者进行了回顾性分析。我们使用控制营养状况（CONUT）评分评估术前免疫营养状况。
我们确定CONUT评分的最佳临界值为1；结果，99例患者中有42例（42.4%）术前CONUT评分异常。单因素分析显示，性别（P = 0.0099）、吸烟状况（P = 0.0176）、病理分期（P = 0.0095）和术前CONUT评分（P = 0.0175）对总生存期（OS）有显著影响。多因素分析显示，病理分期（相对危险度（RR）：2.12；95%置信区间（CI）：1.10 - 3.90；P = 0.0268）和术前CONUT评分（RR：2.10；95%CI：1.20 - 3.67；P = 0.0094）是独立的预后因素。在OS的Kaplan - Meier分析中，术前CONUT评分异常组的OS明显短于术前CONUT评分正常组（P = 0.0152，对数秩检验）；然而，无病生存期（DFS）和癌症特异性生存期（CSS）均无统计学差异（分别为P = 0.9238和P = 0.8661，对数秩检验）。共有22例患者（46.8%）死于肺炎或其他器官恶性肿瘤等其他疾病。
术前CONUT评分异常是老年合并术前合并症的NSCLC患者的不良预后因素，可能预示术后不良结局是由非原发性肺癌而是其他疾病引起的。
