Department of Digestive Surgery, Kawasaki Medical School, 577, Matsushima, Kurashiki, 701-0192, Okayama, Japan.
BMC Cancer. 2024 Jun 18;24(1):745. doi: 10.1186/s12885-024-12512-2.
As gastric cancer patients aged ≥ 85 years have a short life expectancy and often die from other diseases such as pneumonia, indications for surgery are controversial. In this study, we retrospectively analyzed the prognostic factors of elderly patients with gastric cancer who are candidates for curative gastrectomy.
Among 114 patients aged ≥ 85 years with gastric cancer at our hospital between 2010 and 2019, prognostic factors were examined using the Cox proportional hazards model in 76 patients excluding those with cStage IVB or endoscopic submucosal dissection. We also analyzed the factors of pneumonia death.
cStage was I/IIA/IIB/III/IVA in 37/6/14/14/5 patients, respectively. Treatment included distal gastrectomy in 28 patients, total gastrectomy in 6, local resection in 9, others in 3, and no surgery in 30. In univariate analyses of overall survival, Eastern Cooperative Oncology Group Performance Status, physiological score of Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM), Onodera's prognostic nutritional index, cStage, and treatment were prognostic factors. In a multivariate analysis, POSSUM physiological score, cStage, treatment method {no surgery vs. distal gastrectomy: hazard ratio (HR) 5.78, 95% confidence interval (CI) 2.33-14.3}, (total gastrectomy vs. distal gastrectomy: HR 4.26, 95% CI 1.22-14.9) were independent prognostic factors. In univariate analyses of pneumonia-specific survival, treatment (total gastrectomy vs. distal gastrectomy: HR 6.98, 95% CI 1.18-41.3) was the only prognostic factor.
The prognosis of distal gastrectomy was better than that of non-surgery even in patients aged ≥ 85 years. However, total gastrectomy was considered to be avoidable due to the high rate of postoperative pneumonia death.
由于年龄≥85 岁的胃癌患者预期寿命较短，且常死于肺炎等其他疾病，因此手术适应证存在争议。本研究回顾性分析了我院 2010 年至 2019 年间年龄≥85 岁且适合行根治性胃切除术的胃癌患者的预后因素。
在排除 cStage IVB 或内镜黏膜下剥离术的 76 例患者中，使用 Cox 比例风险模型分析了年龄≥85 岁的胃癌患者的预后因素。我们还分析了肺炎死亡的相关因素。
cStage 分别为 I/IIA/IIB/III/IVA 的患者分别为 37/6/14/14/5 例。治疗方法包括远端胃切除术 28 例、全胃切除术 6 例、局部切除术 9 例、其他方法 3 例、无手术 30 例。在总生存的单因素分析中，东部肿瘤协作组体能状态、生理评分、生理学和手术严重程度评分用于死亡率和发病率评估（POSSUM）、小野预后营养指数、cStage 和治疗是预后因素。多因素分析中，POSSUM 生理评分、cStage、治疗方法（无手术与远端胃切除术：风险比（HR）5.78，95%置信区间（CI）2.33-14.3），（全胃切除术与远端胃切除术：HR 4.26，95%CI 1.22-14.9）是独立的预后因素。在肺炎特异性生存的单因素分析中，治疗方法（全胃切除术与远端胃切除术：HR 6.98，95%CI 1.18-41.3）是唯一的预后因素。
即使在年龄≥85 岁的患者中，远端胃切除术的预后也优于非手术治疗。然而，由于术后肺炎死亡率较高，全胃切除术被认为是可以避免的。
