Ito Nobuhito, Funasaka Kohei, Fujiyoshi Toshihisa, Nishida Kazuki, Furukawa Kazuhiro, Kakushima Naomi, Furune Satoshi, Ohno Eizaburo, Nakamura Masanao, Horiguchi Noriyuki, Shibata Tomoyuki, Miyahara Ryoji, Haruta Jun-Ichi, Hirooka Yoshiki, Fujishiro Mitsuhiro, Kawashima Hiroki
Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Aichi, Japan.
Department of Gastroenterology and Hepatology, Fujita Health University School of Medicine, Aichi, Japan.
Dig Endosc. 2023 Jan;35(1):67-76. doi: 10.1111/den.14416. Epub 2022 Sep 1.
Comprehensive assessments of the long-term outcomes of endoscopic submucosal dissection (ESD) for early gastric cancer (EGC) in the elderly are unavailable. We aimed to create a scoring system to predict the long-term prognosis after ESD for EGC among patients aged ≥75 years.
We conducted retrospective studies of two cohorts: a single-center cohort (2006-2011) for developing the scoring system, and a multicenter cohort for validating the developed system (2012-2016). In the development cohort, factors related to death after ESD were identified using multivariable Cox regression analysis, and a predictive scoring system was developed. In the validation cohort, the scoring system was validated in 295 patients.
In the development cohort, Charlson comorbidity index (CCI) ≥3 (hazard ratio [HR] 3.017), high psoas muscle index (PMI) (HR 2.206), and age ≥80 years (HR 1.978) were significantly related to overall survival after ESD. Therefore, high CCI, low PMI, and age ≥80 years were assigned 1 point each. The patients were categorized into low (≤1 point) and high (≥2 points) score groups based on their total scores. In the validation cohort, 184 and 111 patients were assigned to the low- and high-score groups, respectively. In comparisons based on Kaplan-Meier curves, the 5-year survival rate was 91.5% in the low-score group and 57.8% in the high-score group (log-rank test; P < 0.001).
Our scoring system including high CCI, low PMI, and age ≥80 years could stratify the long-term prognosis of elderly patients aged ≥75 years after ESD for EGC.
目前尚无针对老年早期胃癌（EGC）内镜黏膜下剥离术（ESD）长期疗效的综合评估。我们旨在创建一个评分系统，以预测年龄≥75岁的EGC患者ESD术后的长期预后。
我们对两个队列进行了回顾性研究：一个用于开发评分系统的单中心队列（2006 - 2011年），以及一个用于验证所开发系统的多中心队列（2012 - 2016年）。在开发队列中，使用多变量Cox回归分析确定ESD术后与死亡相关的因素，并开发了一个预测评分系统。在验证队列中，对295例患者的评分系统进行了验证。
在开发队列中，Charlson合并症指数（CCI）≥3（风险比[HR] 3.017）、高腰肌指数（PMI）（HR 2.206）和年龄≥80岁（HR 1.978）与ESD术后的总生存期显著相关。因此，高CCI、低PMI和年龄≥80岁各得1分。根据总分将患者分为低（≤1分）和高（≥2分）评分组。在验证队列中，分别有184例和111例患者被归入低评分组和高评分组。基于Kaplan-Meier曲线的比较显示，低评分组的5年生存率为91.5%，高评分组为57.8%（对数秩检验；P < 0.001）。
我们的评分系统包括高CCI、低PMI和年龄≥80岁，可对年龄≥75岁的EGC患者ESD术后的长期预后进行分层。
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