老年胃癌患者根治性手术后长期结局的评估：倾向评分匹配分析。

Appraisal of long-time outcomes after curative surgery in elderly patients with gastric cancer: a propensity score matching analysis.

机构信息

Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Tottori University Faculty of Medicine, Yonago, 683-8504, Japan.

Department of Surgery, Japanese Red Cross Tottori Hospital, Tottori, 680-8517, Japan.

出版信息

BMC Surg. 2021 Jan 9;21(1):33. doi: 10.1186/s12893-021-01046-0.

DOI:10.1186/s12893-021-01046-0

PMID:33422067

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7797086/

Abstract

BACKGROUND

This study was conducted to assess the long-term outcomes of elderly patients among propensity-score-matched gastric cancer patients after curative gastrectomy and to propose the proper management of elderly gastric cancer patients.

METHODS

We enrolled 626 patients with gastric cancer who underwent curative gastrectomy at our institution between January 2004 and December 2015. To minimize selection bias among 2 groups, propensity score matching was performed.

RESULTS

Patients were divided into an elderly group over 75 years old (EP group; n = 186) and a non-elderly group (NEP group; n = 440). After propensity score matching, patients were divided into EP group (n = 178) and NEP group (n = 175). Five-year overall survival was significantly lower in the EP group than in the NEP group, consistent with a subgroup analysis of each stage. However, the 5-year disease-specific survival among all enrolled patients and those with stage I and II disease did not differ significantly. Moreover, in the subgroup of stage III patients, 5 year disease-specific survival was significantly lower in the EP group (23.0%) than in the NEP group (59.4%; P = 0.004). Because elderly patients with stage III disease had an extremely poor prognosis, we decided to compare the two groups with stage III. The EP group contained significantly fewer patients with D2 lymphadectomy (P = 0.002) and adjuvant chemotherapy (P < 0.001) than the NEP group. C-reactive protein to albumin ratio was significantly higher in patients in the EP group than in the NEP group (P = 0.046), and the prognostic nutritional index was significantly lower in patients in the EP group than in the NEP group (P = 0.045).　Multivariate analysis revealed that the prognostic nutritional index and lymphatic invasion were independent prognostic factors.

CONCLUSIONS

Elderly gastric cancer patients with stage III disease showed poorer disease-specific survival compared with non-elderly patients, which may be due to a poorer nutritional and inflammatory background, fewer D2 lymphadenectomies, and a lack of adjuvant chemotherapy. The safe induction of standard lymphadenectomy and adjuvant chemotherapy with perioperative aggressive nutritional support may improve the prognosis of elderly gastric cancer patients with stage III disease.

摘要

背景

本研究旨在评估行根治性胃切除术后老年患者与匹配倾向评分的非老年胃癌患者的长期预后，并为老年胃癌患者的治疗提供指导。

方法

我们纳入了 2004 年 1 月至 2015 年 12 月在我院接受根治性胃切除术的 626 例胃癌患者。为了在两组之间尽量减少选择偏倚，我们进行了倾向评分匹配。

结果

患者分为 75 岁以上的老年组（EP 组，n=186）和非老年组（NEP 组，n=440）。经过倾向评分匹配后，患者被分为 EP 组（n=178）和 NEP 组（n=175）。EP 组的 5 年总生存率明显低于 NEP 组，与各分期的亚组分析一致。然而，所有入组患者和 I 期和 II 期患者的 5 年疾病特异性生存率无显著差异。此外，在 III 期患者亚组中，EP 组（23.0%）的 5 年疾病特异性生存率明显低于 NEP 组（59.4%；P=0.004）。由于 III 期老年患者预后极差，我们决定将两组患者与 III 期患者进行比较。EP 组行 D2 淋巴结清扫术（P=0.002）和辅助化疗（P<0.001）的患者明显少于 NEP 组。EP 组患者的 C 反应蛋白与白蛋白比值明显高于 NEP 组（P=0.046），EP 组患者的预后营养指数明显低于 NEP 组（P=0.045）。多因素分析显示，预后营养指数和淋巴血管侵犯是独立的预后因素。