Shannon Adrienne B, Song Yun, Fraker Douglas L, Roses Robert E, DeMatteo Ronald P, Miura John T, Karakousis Giorgos C
Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 4 Silverstein, Philadelphia, PA, 19146, USA.
Department of Surgery, Hospital of the University of Pennsylvania, 3400 Spruce Street, 4 Silverstein, Philadelphia, PA, 19146, USA.
Am J Surg. 2022 Feb;223(2):325-330. doi: 10.1016/j.amjsurg.2021.03.062. Epub 2021 Apr 16.
Localized gastrointestinal stromal tumors (GISTs) are rare tumors typically managed with surgery, but outcomes among octogenarians remain less studied.
Octogenarian patients with stage I-III gastric GISTs were identified from the National Cancer Database and classified by resection status. Cox regression and Kaplan-Meier survival analyses analyzed 5-year overall survival (OS). Ninety-day mortality was analyzed following 1:1 propensity score matching.
Identified octogenarians (N = 949) who underwent resection (N = 632) had improved adjusted OS (71% vs 59.6%, HR 0.75, p 0.049) as compared to non-resected patients. Following matching, 90-day mortality was 5.7% and 11% in resected and non-resected patients (p 0.052), respectively. After exclusion of patients with 90-day mortality, resected patients maintained an OS advantage (77.3% vs 71.1%, HR 0.64, p 0.028).
The majority of octogenarians with localized gastric GIST are treated with surgery portending improved survival but an appreciable mortality, suggesting a necessity for careful selection of older patients for surgery.
局限性胃肠道间质瘤（GISTs）是罕见肿瘤，通常通过手术治疗，但对八旬老人的治疗结果研究较少。
从国家癌症数据库中识别出患有I - III期胃GIST的八旬老人患者，并根据切除状态进行分类。采用Cox回归和Kaplan - Meier生存分析评估5年总生存率（OS）。通过1:1倾向评分匹配分析90天死亡率。
已识别的接受手术的八旬老人（N = 949，其中N = 632接受了切除手术）与未接受手术的患者相比，调整后的总生存率有所提高（71%对59.6%，HR 0.75，p 0.049）。匹配后，接受手术和未接受手术的患者90天死亡率分别为5.7%和11%（p 0.052）。排除90天内死亡的患者后，接受手术的患者仍保持总生存优势（77.3%对71.1%，HR 0.64，p 0.028）。
大多数患有局限性胃GIST的八旬老人接受手术治疗，这预示着生存率提高，但死亡率也相当可观，这表明有必要谨慎选择老年患者进行手术。
