老年结直肠癌患者非结直肠癌相关死亡风险：五种术前风险评估指标的比较。

Risk of non-colorectal cancer-related death in elderly patients with the disease: A comparison of five preoperative risk assessment indices.

机构信息

Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan.

Division of Frontier Surgery, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.

出版信息

Cancer Med. 2023 Feb;12(3):2290-2302. doi: 10.1002/cam4.5052. Epub 2022 Jul 24.

DOI:10.1002/cam4.5052

PMID:35871776

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9939130/

Abstract

BACKGROUND

A considerable number of elderly patients with colorectal cancer (CRC) die of non-CRC-related causes. The Controlling Nutritional Status (CONUT) score, American Society of Anesthesiologists Physical Status classification, Charlson Comorbidity Index, National Institute on Aging, and National Cancer Institute Comorbidity Index, and Adult Comorbidity Evaluation-27 score are all known predictors of survival in patients with CRC. However, the utility of these indices for predicting non-CRC-related death in elderly CRC patients is not known.

METHODS

The study population comprised 364 patients aged 80 years or more who received curative resection for stage I-III CRC between 2000 and 2016. The association of each index with non-CRC-related death was compared by competing-risks analysis such as the cumulative incidence function and proportional subdistribution hazards regression analysis as well as time-dependent receiver-operating characteristic (ROC) analysis.

RESULTS

There were 85 deaths (40 CRC-related and 45 non-CRC-related) during a median observation period of 53.2 months. Cumulative incidence function analysis identified CONUT score as the most suitable for risk stratification for non-CRC-related death. In proportional subdistribution hazards regression, risk of non-CRC-related death increased significantly as CONUT score worsened (2/3/4 vs. 0/1, hazard ratio 1.73, 95% confidence interval [CI] 0.91-3.15; ≥5 vs. 2/3/4, hazard ratio 2.71, 95% CI 1.08-6.81). Time-dependent ROC curve analysis showed that CONUT score were consistently superior to other indices during the 5-year observation period.

CONCLUSIONS

The majority of deaths in elderly patients with CRC were not CRC-related. CONUT score was the most useful predictor of non-CRC-related death in these patients.

摘要

背景

相当数量的老年结直肠癌（CRC）患者死于非 CRC 相关原因。控制营养状况（CONUT）评分、美国麻醉医师协会身体状况分类、Charlson 合并症指数、美国国家老龄化研究所和国家癌症研究所合并症指数以及成人合并症评估-27 评分均为 CRC 患者生存的已知预测指标。然而，这些指标对于预测老年 CRC 患者非 CRC 相关死亡的作用尚不清楚。

方法

本研究纳入了 2000 年至 2016 年间接受 I-III 期 CRC 根治性切除术的 364 名年龄 80 岁及以上的患者。采用竞争风险分析（如累积发生率函数和比例亚分布风险回归分析）以及时间依赖性接受者操作特征（ROC）分析比较了各指标与非 CRC 相关死亡的关系。

结果

在中位观察期为 53.2 个月期间，有 85 例患者死亡（40 例 CRC 相关死亡，45 例非 CRC 相关死亡）。累积发生率函数分析发现 CONUT 评分最适合用于非 CRC 相关死亡的风险分层。在比例亚分布风险回归中，随着 CONUT 评分的恶化，非 CRC 相关死亡的风险显著增加（2/3/4 分 vs. 0/1 分，风险比 1.73，95%置信区间 [CI] 0.91-3.15；≥5 分 vs. 2/3/4 分，风险比 2.71，95% CI 1.08-6.81）。时间依赖性 ROC 曲线分析表明，在 5 年观察期间，CONUT 评分始终优于其他指标。