Iida Michihisa, Takeda Shigeru, Nakashima Chiyo, Nishiyama Mitsuo, Watanabe Yusaku, Suzuki Nobuaki, Yoshino Shigefumi, Nakagami Yuki, Tanabe Tsuyoshi, Nagano Hiroaki
Department of Gastroenterological, Breast and Endocrine Surgery Yamaguchi University Graduate School of Medicine Yamaguchi Japan.
National Hospital Organization Kanmon Medical Center Yamaguchi Japan.
Ann Gastroenterol Surg. 2022 Jun 20;6(6):753-766. doi: 10.1002/ags3.12588. eCollection 2022 Nov.
To identify preoperative factors, especially other diseases that cause death, that are associated with the prognosis of gastrectomy in elderly patients with gastric cancer.
This retrospective study included a total of 211 consecutive patients aged ≥75 years who underwent radical gastrectomy due to gastric cancer. Time-dependent receiver operating characteristic curve analysis was performed to determine the optimal cutoff values for various perioperative factors. Risk factors for the overall survival and death from other diseases were analyzed using the Cox proportional hazards model.
Among the all perioperative factors, sex, neutrophil-to-lymphocyte ratio, skeletal muscle mass index, and lymph node dissection in accordance with guidelines or not extracted as independent risk factors for death from other diseases. In an analysis restricted to the preoperative factors, sex, neutrophil-to-lymphocyte ratio, and skeletal muscle mass index of the patients were extracted as independent risk factors for death from other diseases and overall survival. We divided the patients into four groups according to the number of preoperative risk factors for death from other diseases and found that the 5-year non-gastric-cancer-related survival was different among the four groups (risk factor 0, 91.7%; risk factor 1, 83.3%; risk factor 2, 56.3%; risk factor 3, 27.2%; < 0.001).
Male sex, low skeletal muscle mass index, and high neutrophil-to-lymphocyte ratio are risk factors for non-gastric-cancer-related death and the overall survival of elderly patients undergoing gastrectomy. Cautious treatment strategies are needed for elderly gastric cancer patients with many risk factors.
确定与老年胃癌患者胃切除术后预后相关的术前因素，尤其是导致死亡的其他疾病。
这项回顾性研究纳入了总共211例年龄≥75岁、因胃癌接受根治性胃切除术的连续患者。进行时间依赖性受试者工作特征曲线分析，以确定各种围手术期因素的最佳截断值。使用Cox比例风险模型分析总生存和其他疾病死亡的危险因素。
在所有围手术期因素中，性别、中性粒细胞与淋巴细胞比值、骨骼肌质量指数以及是否按照指南进行淋巴结清扫未被提取为其他疾病死亡的独立危险因素。在仅限于术前因素的分析中，患者的性别、中性粒细胞与淋巴细胞比值和骨骼肌质量指数被提取为其他疾病死亡和总生存的独立危险因素。我们根据术前其他疾病死亡危险因素的数量将患者分为四组，发现四组之间的5年非胃癌相关生存率不同（危险因素0，91.7%；危险因素1，83.3%；危险因素2，56.3%；危险因素3，27.2%；P<0.001）。
男性、低骨骼肌质量指数和高中性粒细胞与淋巴细胞比值是接受胃切除术的老年患者非胃癌相关死亡和总生存的危险因素。对于有许多危险因素的老年胃癌患者，需要谨慎的治疗策略。
