Huang Lei, Liu Yunmei, Wang Lei, Rong Lan, Hu Weiguo
National Key Laboratory of Immunity and Inflammation, Changhai Clinical Research Unit, Department of Gastroenterology, National Clinical Research Center for Digestive Diseases, The First Affiliated Hospital of Naval Medical University/Changhai Hospital, Naval Medical University, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
Medical Center on Aging of Ruijin Hospital, MCARJH, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.
Eur Geriatr Med. 2024 Dec;15(6):1909-1927. doi: 10.1007/s41999-024-01059-x. Epub 2024 Sep 21.
Gastric cancer (GC) is mostly a disease of aging, and older patients with GC are generally frailer. This study aimed to describe the characteristics and in-hospital outcomes, both overall and stratified by gender and resection, and to explore factors associated with outcomes of first hospitalization, in older GC patients.
Data on GC patients ≥ 65 years hospitalized from January 2016 until December 2020 were retrieved from the electronic medical records of a large tertiary hospital. Patient and tumor characteristics, duration and fee of hospitalization, and in-hospital mortality were described for overall patients and compared by gender and resection. Factors associated with outcomes of first hospitalization were explored using multivariable-adjusted logistic regression.
3238 eligible patients were analyzed, with a mean age of 71 years and a male proportion of 74%. The median duration and fee of first hospitalization were 13 days and 40,000 RMB, respectively, with a median fee of 17,000 RMB not covered by insurance. 16 (< 1%) and 32 (1%) deaths occurred during first and any hospitalization, respectively, with only 4 (< 1%) perioperative deaths. Compared to male patients, female cases had more often signet-ring-cell carcinoma, reduced food intake, resection, and history of major abdominal surgery. Compared to unresected cases, resected patients had higher body-mass-index and Barthel index, less often reduced food intake, weight loss, and risk of malnutrition, and more often common diet, longer hospital stay, and higher fee. Through multivariable-adjusted analysis, longer first hospital-stay was associated with earlier year of diagnosis, older ages, emergency admission, signet-ring-cell carcinoma, resection, history of anticoagulant intake, larger body-mass-index, non-common diet, and non-low-salt and non-diabetes diets; higher fee of first hospitalization was associated with later year of diagnosis, male gender, older ages, emergency admission, signet-ring-cell carcinoma, and resection.
In this large institution-based study, older GC patients had low in-hospital mortality rates; the insurance coverage needs to be improved. Several characteristics and in-hospital outcomes significantly differed by gender and resection status, and various factors associated with duration and fee of first hospitalization were identified, providing important hints for individualized and stratified geriatric GC care.
胃癌（GC）主要是一种老年疾病，老年GC患者通常更为虚弱。本研究旨在描述老年GC患者首次住院的总体特征及住院结局，并按性别和手术切除情况进行分层分析，同时探索与首次住院结局相关的因素。
从一家大型三级医院的电子病历中检索2016年1月至2020年12月期间住院的年龄≥65岁的GC患者数据。描述了所有患者的患者和肿瘤特征、住院时间和费用以及住院死亡率，并按性别和手术切除情况进行比较。使用多变量调整逻辑回归探索与首次住院结局相关的因素。
共分析了3238例符合条件的患者，平均年龄71岁，男性占74%。首次住院的中位时间和费用分别为13天和40,000元人民币，其中17,000元人民币的中位费用未纳入医保报销范围。首次住院期间有16例（<1%）死亡，任何住院期间有32例（1%）死亡，围手术期死亡仅4例（<1%）。与男性患者相比，女性患者黏液腺癌更多见，进食减少、接受手术切除以及有腹部大手术史的情况更常见。与未接受手术切除的患者相比，接受手术切除的患者体重指数和巴氏指数更高，进食减少、体重减轻和营养不良风险的情况较少见，普通饮食、住院时间更长和费用更高的情况更常见。通过多变量调整分析，首次住院时间较长与诊断年份较早、年龄较大、急诊入院、黏液腺癌、手术切除、抗凝药物服用史、体重指数较大、非普通饮食以及非低盐和非糖尿病饮食有关；首次住院费用较高与诊断年份较晚、男性、年龄较大、急诊入院、黏液腺癌和手术切除有关。
在这项基于大型机构的研究中，老年GC患者住院死亡率较低；医保覆盖范围有待提高。性别和手术切除状态在一些特征和住院结局方面存在显著差异，并且确定了与首次住院时间和费用相关的各种因素，为老年GC患者的个体化和分层护理提供了重要线索。
