术前营养评估对行腹腔镜胃癌根治术的Ⅰ-Ⅲ期老年胃癌患者的预后意义。

Prognostic Significance of Preoperative Nutritional Assessment in Elderly Patients who Underwent Laparoscopic Gastrectomy for Stage I-III Gastric Cancer.

机构信息

Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan

Department of Gastroenterological Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan.

出版信息

Anticancer Res. 2023 Feb;43(2):893-901. doi: 10.21873/anticanres.16232.

DOI:10.21873/anticanres.16232

PMID:36697095

Abstract

BACKGROUND/AIM: Surgery for elderly patients with gastric cancer is becoming more common. However, the risk factors of the laparoscopic surgery for these patients are unknown, and thus it is difficult to determine appropriate treatments for such patients. The aim of this retrospective study was to clarify the risk factors for the treatment outcomes after laparoscopic gastrectomy in elderly patients.

PATIENTS AND METHODS

Two hundred twenty-two patients who underwent laparoscopic gastrectomy for primary gastric cancer between January 2014 and December 2017 were enrolled. Clinical characteristics and short- and long-term prognoses were analyzed in 47 patients aged 75 years or older (elderly group) and in 175 patients who were under 75 years old (non-elderly group).

RESULTS

The presence of comorbidities was more common in the elderly group than in the non-elderly group (91.5% vs. 61.7%, p<0.0001). The rate of postoperative complications in the elderly group was significantly higher than that in the non-elderly group (42.6% vs. 22.9%, p=0.01). The 5-year overall survival rate was significantly lower in the elderly group than in the non-elderly group (66.9% vs. 92.2%; p<0.0001). In the elderly group, 5-year overall survival in patients with a low preoperative prognostic nutritional index (PNI) was significantly worse than that in patients with a high preoperative PNI (25.0% vs. 80.9%; p<0.05). Multivariate analysis showed that the PNI value was independently associated with overall survival in elderly patients who underwent laparoscopic gastrectomy (p<0.05). In particular, the rate of non-cancer deaths after surgery in elderly patients was significantly higher than that in non-elderly patients (p<0.05).

CONCLUSION

PNI value is an independent prognostic factor for overall survival in elderly patients who have undergone laparoscopic gastrectomy for gastric cancer; therefore, in elderly patients with low preoperative PNI, attention should be paid not only to recurrence of cancer, but also to the deterioration of general condition caused by malnutrition.

摘要

背景/目的：老年胃癌患者的手术治疗越来越常见。然而，这些患者接受腹腔镜手术的风险因素尚不清楚，因此难以为这些患者制定合适的治疗方案。本回顾性研究旨在阐明腹腔镜胃癌根治术治疗老年患者的疗效相关的风险因素。

方法

纳入 2014 年 1 月至 2017 年 12 月期间接受腹腔镜胃癌根治术的 222 例原发性胃癌患者。分析 47 例年龄≥75 岁（老年组）和 175 例年龄<75 岁（非老年组）患者的临床特征和短期及长期预后。

结果

老年组患者的合并症发生率高于非老年组（91.5% vs. 61.7%，p<0.0001）。老年组患者的术后并发症发生率明显高于非老年组（42.6% vs. 22.9%，p=0.01）。老年组患者的 5 年总生存率明显低于非老年组（66.9% vs. 92.2%；p<0.0001）。老年组中，术前低预后营养指数（PNI）患者的 5 年总生存率明显低于术前高 PNI 患者（25.0% vs. 80.9%；p<0.05）。多因素分析显示，PNI 值与接受腹腔镜胃癌根治术的老年患者的总生存独立相关（p<0.05）。特别是，老年患者术后非癌症死亡率明显高于非老年患者（p<0.05）。