≥85岁老年早期胃癌患者内镜下黏膜下剥离术后3年生存预测模型：EGC-2模型
Prediction model of 3-year survival after endoscopic submucosal dissection for early gastric cancer in elderly patients aged ≥ 85 years: EGC-2 model.
作者信息
Toya Yosuke, Shimada Tomohiro, Hamada Koichi, Watanabe Ko, Nakamura Jun, Fukushi Daisuke, Hatta Waku, Shinkai Hirohiko, Ito Hirotaka, Matsuhashi Tamotsu, Fujimori Shusei, Iwai Wataru, Hanabata Norihiro, Shiroki Takeharu, Sasaki Yu, Fujishima Yuukou, Tsuji Tsuyotoshi, Yorozu Haruka, Yoshimura Tetsuro, Horikawa Yohei, Takahashi Yasushi, Takahashi Hiroshi, Kondo Yutaka, Fujiwara Takao, Mizugai Hisata, Gonai Takahiro, Tatsuta Tetsuya, Onochi Kengo, Kudara Norihiko, Abe Keinosuke, Ohira Tetsuya, Horikawa Yoshinori, Ishihata Ryoichi, Hikichi Takuto, Satoh Kennichi, Takahashi Fumiaki, Masamune Atsushi, Iijima Katsunori, Fukuda Shinsaku, Matsumoto Takayuki
机构信息
Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Idaidori 1-1-1, Yahaba, 028-3694, Japan.
Department of Gastroenterology, Sendai City Medical Center, Sendai, Japan.
出版信息
J Cancer Res Clin Oncol. 2023 Apr;149(4):1521-1530. doi: 10.1007/s00432-022-04024-y. Epub 2022 May 11.
PURPOSE
Little is known about the prognostic factors for survival after endoscopic submucosal dissection (ESD) in elderly patients with early gastric cancer (EGC). The aim of this study is to determine prognostic factors and a prediction model of 3-year survival after ESD for EGC in patients aged ≥ 85 years.
METHODS
We retrospectively evaluated the clinical outcomes of 740 patients with EGC aged ≥ 85 years, who were treated by ESD at 30 institutions in Japan. Overall survival (OS) and disease-specific survival (DSS) were calculated with the Kaplan-Meier method. Prediction models for 3-year OS after ESD were estimated using the Cox proportional hazards model based on Uno's C-statistics.
RESULTS
During the follow-up period, 309 patients died of any cause and 10 patients died of gastric cancer. OS and DSS after 3 years were 82.7% and 99.2%, respectively. No significant differences in OS were found among curability categories. The Cox proportional hazards model revealed the geriatric nutritional risk index (GNRI) and the Charlson comorbidity index (CCI) to be predictors of 3-year survival. We established a final model (EGC-2 model) expressed by GNRI - (2.2×CCI) with a cutoff value of 96. The overall survival rate was significantly lower in the model value < 96 group than in the model value ≥ 96 group (P < 0.001).
CONCLUSIONS
The prediction model using GNRI and CCI will be useful to support decision-making for the treatment of EGC in elderly patients aged ≥ 85 years.
目的
关于老年早期胃癌（EGC）患者内镜黏膜下剥离术（ESD）后生存的预后因素知之甚少。本研究的目的是确定年龄≥85岁的EGC患者ESD后3年生存的预后因素和预测模型。
方法
我们回顾性评估了日本30家机构接受ESD治疗的740例年龄≥85岁的EGC患者的临床结局。采用Kaplan-Meier法计算总生存（OS）和疾病特异性生存（DSS）。基于Uno的C统计量，使用Cox比例风险模型估计ESD后3年OS的预测模型。
结果
随访期间，309例患者死于任何原因，10例患者死于胃癌。3年后的OS和DSS分别为82.7%和99.2%。在治愈类别之间未发现OS有显著差异。Cox比例风险模型显示老年营养风险指数（GNRI）和Charlson合并症指数（CCI）是3年生存的预测因素。我们建立了一个最终模型（EGC-2模型），其表达式为GNRI - （2.2×CCI），临界值为96。模型值<96组的总生存率显著低于模型值≥96组（P<0.001）。
结论
使用GNRI和CCI的预测模型将有助于支持对年龄≥85岁的老年EGC患者治疗的决策。
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