老年肺癌患者行广泛开肺切除术是否合理？
Are Extensive Open Lung Resections for Elderly Patients with Lung Cancer Justified?
机构信息
Department of Thoracic Surgery, 'Olympion' General Clinic, 26443 Patras, Greece.
Department of Thoracic Surgery, University Medicine Essen-Ruhrlandklinik, 45239 Essen, Germany.
出版信息
Curr Oncol. 2023 Jun 5;30(6):5470-5484. doi: 10.3390/curroncol30060414.
BACKGROUND
Older patients with malignancies are more comorbid than younger ones and are usually undertreated only because of their age. The aim of this study is to investigate the safety of open anatomical lung resections for lung cancer in elderly patients.
METHODS
We retrospectively analyzed all patients who underwent lung resection for lung cancer in our institution and categorized them into two groups: the elderly group (≥70 years old) and the control (<70).
RESULTS
In total, 135 patients were included in the elderly group and 375 in the control. Elderly patients were more frequently diagnosed with squamous cell carcinoma (59.3% vs. 51.5%, = 0.037), higher differentiated tumors (12.6% vs. 6.4%, = 0.014), and at an earlier stage (stage I: 55.6% for elderly vs. 36.6%, = 0.002). Elderly patients were more vulnerable to postoperative pneumonia (3.7% vs. 0.8%, = 0.034), lung atelectasis (7.4% vs. 2.9%, = 0.040), and pleural empyema (3.2% vs. 0%, = 0.042), however, with no increased 30-day-mortality (5.2% for elderly vs. 2.7%, = 0.168). Survival was comparable in both groups (43.4 vs. 45.3 months, = 0.579).
CONCLUSIONS
Elderly patients should not be excluded from open major lung resections as the survival benefit is not reduced in selected patients.
背景
老年恶性肿瘤患者比年轻患者合并症更多，而且通常仅仅因为年龄原因而接受不充分的治疗。本研究旨在探讨高龄患者行开放性解剖性肺切除术治疗肺癌的安全性。
方法
我们回顾性分析了在我院行肺切除术治疗肺癌的所有患者，并将其分为两组：老年组（≥70 岁）和对照组（＜70 岁）。
结果
共有 135 例患者归入老年组，375 例归入对照组。老年患者更常被诊断为鳞状细胞癌（59.3%比 51.5%， = 0.037），分化程度更高（12.6%比 6.4%， = 0.014），分期更早（Ⅰ期：老年组 55.6%比 36.6%， = 0.002）。老年患者更易发生术后肺炎（3.7%比 0.8%， = 0.034）、肺不张（7.4%比 2.9%， = 0.040）和脓胸（3.2%比 0%， = 0.042），但 30 天死亡率无增加（老年组 5.2%比 2.7%， = 0.168）。两组患者的生存情况无差异（43.4 比 45.3 个月， = 0.579）。
结论
在选择合适的患者中，不应将高龄患者排除在开放性大肺切除术之外，因为这并不会降低患者的生存获益。
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