Department of Gastroenterological Surgery, Saitama Cancer Center, 780 Komuro Inamachi, , Kitaadachi-Gun, Saitama, 362-0806, Japan.
Department of Gastroenterology, Saitama Cancer Center, Saitama, Japan.
World J Surg. 2023 Dec;47(12):3229-3239. doi: 10.1007/s00268-023-07195-y. Epub 2023 Oct 6.
Preoperative physiological assessments are crucial for optimizing clinical outcomes, especially those of elderly esophageal cancer (EC) patients who are generally frail and at the high risk of mortality.
Patients who underwent surgery for EC between 2004 and 2018 were retrospectively reviewed. Patients were categorized into elderly (>70 years) or non-elderly (≤70 years) groups. Various physiological parameters including the Charlson Comorbidity Index (CCI), immunonutritional parameters and pulmonary functions were studied. Pulmonary functions included %vital capacity (VC) and forced expiratory volume in one second (FEV1.0) and FEV1.0%. The thresholds were set as the lowest quartile (100% for %VC and 2L for FEV1.0) in this cohort. Multivariate Cox hazards models were applied to determine independent predictors of non-EC-related deaths.
In total, 824 patients were included (elderly; n = 306, non-elderly; n = 518). Elderly patients had a significantly lower 5-year OS rate than non-elderly patients (53.3% vs. 57.2%, P = 0.03), mainly due to increased risk of death from non-EC related causes. In the elderly group, multivariate Cox hazards analysis identified 3 independent predictors of non-EC-related deaths; high CCI (HR 1.98, P=0.006), low %VC (HR 2.01, P = 0.004) and low FEV1.0 (HR 1.6, P=0.048). Elderly patients without risk factors had a significantly better 5-year OS rate (63.5%) than those with 1 (50.0%) or 2-3 (36.3%) risk factors (P <0.01). Deaths due to pulmonary disease rose significantly as the number of risk factors increased (P=0.03).
The severity of comorbidities and pulmonary function impairments are useful for predicting long-term outcomes, especially non-EC-related deaths, in elderly EC patients.
术前生理评估对于优化临床结局至关重要，尤其是对于那些身体虚弱且死亡率较高的老年食管癌（EC）患者。
回顾性分析 2004 年至 2018 年间接受手术治疗的 EC 患者。患者分为老年组（>70 岁）和非老年组（≤70 岁）。研究了各种生理参数，包括 Charlson 合并症指数（CCI）、免疫营养参数和肺功能。肺功能包括肺活量百分比（%VC）和 1 秒用力呼气量（FEV1.0）和 FEV1.0%。在本队列中，将这些阈值设定为最低四分位数（%VC 为 100%，FEV1.0 为 2L）。采用多变量 Cox 风险模型确定与非 EC 相关死亡的独立预测因素。
共纳入 824 例患者（老年组，n=306；非老年组，n=518）。老年患者的 5 年总生存率明显低于非老年患者（53.3% vs. 57.2%，P=0.03），主要是由于非 EC 相关死亡风险增加。在老年组中，多变量 Cox 风险分析确定了 3 个与非 EC 相关死亡的独立预测因素；CCI 高（HR 1.98，P=0.006）、%VC 低（HR 2.01，P=0.004）和 FEV1.0 低（HR 1.6，P=0.048）。无危险因素的老年患者的 5 年总生存率（63.5%）明显高于有 1（50.0%）或 2-3 个（36.3%）危险因素的患者（P<0.01）。随着危险因素数量的增加，死于肺部疾病的患者比例显著增加（P=0.03）。
合并症的严重程度和肺功能损害程度可用于预测老年 EC 患者的长期结局，尤其是与非 EC 相关的死亡。
