Department of Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital Nieuwegein, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Department of Anesthesiology and Intensive Care, St. Antonius Hospital Nieuwegein, Utrecht, The Netherlands.
Ann Surg Oncol. 2022 Sep;29(9):6031-6042. doi: 10.1245/s10434-022-11831-7. Epub 2022 Jun 2.
The number of elderly patients with pancreatic cancer is growing, however clinical data on the short-term outcomes, rate of adjuvant chemotherapy, and survival in these patients are limited and we therefore performed a nationwide analysis.
Data from the prospective Dutch Pancreatic Cancer Audit were analyzed, including all patients undergoing pancreatic cancer resection between January 2014 and December 2016. Patients were classified into two age groups: <75 and ≥75 years. Major complications (Clavien-Dindo grade 3 or higher), 90-day mortality, rates of adjuvant chemotherapy, and survival were compared between age groups. Factors associated with start of adjuvant chemotherapy and survival were evaluated with logistic regression and multivariable Cox regression analysis.
Of 836 patients, 198 were aged ≥75 years (24%) and 638 were aged <75 years (76%). Median follow-up was 38 months (interquartile range [IQR] 31-47). Major complications (31% vs. 28%; p = 0.43) and 90-day mortality (8% vs. 5%; p = 0.18) did not differ. Adjuvant chemotherapy was started in 37% of patients aged ≥75 years versus 69% of patients aged <75 years (p < 0.001). Median overall survival (OS) was 15 months (95% confidence interval [CI] 14-18) versus 21 months (95% CI 19-24; p < 0.001). Age ≥75 years was not independently associated with OS (hazard ratio 0.96, 95% CI 0.79-1.17; p = 0.71), but was associated with a lower rate of adjuvant chemotherapy (odds ratio 0.27, 95% CI 0.18-0.40; p < 0.001).
The rate of major complications and 90-day mortality after pancreatic resection did not differ between elderly and younger patients; however, elderly patients were less often treated with adjuvant chemotherapy and their OS was shorter.
患有胰腺癌的老年患者人数不断增加，然而，有关这些患者的短期预后、辅助化疗率和生存率的临床数据有限，因此我们进行了一项全国性分析。
分析了前瞻性荷兰胰腺癌症审计的数据，其中包括 2014 年 1 月至 2016 年 12 月期间接受胰腺癌切除术的所有患者。患者分为两个年龄组：<75 岁和≥75 岁。比较了两个年龄组之间的主要并发症（Clavien-Dindo 分级 3 级或更高）、90 天死亡率、辅助化疗率和生存率。使用逻辑回归和多变量 Cox 回归分析评估与辅助化疗开始和生存相关的因素。
在 836 名患者中，有 198 名年龄≥75 岁（24%），638 名年龄<75 岁（76%）。中位随访时间为 38 个月（四分位距 [IQR] 31-47）。主要并发症（31%比 28%；p=0.43）和 90 天死亡率（8%比 5%；p=0.18）无差异。≥75 岁的患者中有 37%开始接受辅助化疗，而<75 岁的患者中有 69%开始接受辅助化疗（p<0.001）。中位总生存期（OS）为 15 个月（95%置信区间 [CI] 14-18），21 个月（95%CI 19-24；p<0.001）。年龄≥75 岁与 OS 无关（风险比 0.96，95%CI 0.79-1.17；p=0.71），但与辅助化疗率较低相关（优势比 0.27，95%CI 0.18-0.40；p<0.001）。
胰腺切除术后老年患者和年轻患者的主要并发症和 90 天死亡率无差异；然而，老年患者接受辅助化疗的比例较低，其 OS 较短。
