First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 4093898, Japan.
World J Surg Oncol. 2020 Oct 30;18(1):283. doi: 10.1186/s12957-020-02052-x.
The number of elderly patients with gastric cancer has been increasing. Most elderly patients have associated reduced physiologic functions that can sometimes become an obstacle to safe surgical treatment. The National Clinical Database Risk Calculator, which based on a large Japanese surgical database, provides predicted mortality and morbidity in each case as the surgical-related risks. The purpose of this study was to investigate the clinical significance of the risk for operative mortality (NRC-mortality), as calculated by the National Clinical Database Risk Calculator, during long-term follow-up after gastrectomy for elderly patients with gastric cancer.
We enrolled 73 patients aged ≥ 80 years and underwent gastrectomy at our institution. Their surgical risk was evaluated based on the NRC-mortality. Several clinicopathologic factors, including NRC-mortality, were selected and analyzed as the possible prognostic factors for elderly patients who have undergone gastrectomy for gastric cancer. Statistical analysis was performed using the log-rank test and Cox proportional hazard model.
NRC-mortality ranged from 0.5 to 10.6%, and the median value was 1.7%. Dividing the patients according to mortality, the overall survival was significantly worse in the high mortality group (≥ 1.7%, n = 38) than in the low mortality group (< 1.7%, n = 35), whereas disease-specific survival was not different between the two groups. In the Cox proportional hazard model, multivariate analysis revealed NRC-mortality, performance status, and surgical procedure as the independent prognostic factors for overall survival. For disease-specific survival, the independent prognostic factors were performance status and pathological stage but not NRC-mortality.
The NRC-mortality might be clinically useful for predicting both surgical mortality and overall survival after gastrectomy in elderly patients with gastric cancer.
老年胃癌患者的数量一直在增加。大多数老年患者的生理机能下降，这有时会成为安全手术治疗的障碍。国家临床数据库风险计算器是基于一个大型日本手术数据库，为每个病例提供预测的死亡率和发病率，作为手术相关风险。本研究旨在探讨在接受胃癌根治术后的长期随访中，国家临床数据库风险计算器计算的手术死亡率（NRC-死亡率）的临床意义。
我们纳入了在我院接受胃切除术的 73 名年龄≥80 岁的患者。根据 NRC-死亡率评估他们的手术风险。选择了几种临床病理因素，包括 NRC-死亡率，并将其分析为接受胃癌根治术的老年患者的可能预后因素。使用对数秩检验和 Cox 比例风险模型进行统计分析。
NRC-死亡率范围为 0.5%至 10.6%，中位数为 1.7%。根据死亡率将患者分组，高死亡率组（≥1.7%，n=38）的总生存率明显低于低死亡率组（<1.7%，n=35），而两组的疾病特异性生存率无差异。在 Cox 比例风险模型中，多变量分析显示 NRC-死亡率、体能状态和手术方式是总生存率的独立预后因素。对于疾病特异性生存率，独立的预后因素是体能状态和病理分期，但不是 NRC-死亡率。
NRC-死亡率可能对预测老年胃癌患者胃切除术后的手术死亡率和总生存率具有临床意义。
