Nagano Keitaro, Kuba Kiyomi, Osaki Masami, Hatanaka Akio, Hara Mutsuko, Manaka Kazue, Kinoshita Shingo, Kazuhiro Mitsumura, Mukae Ryohei, Umino Masaya
Department of Otolaryngology, Head and Neck Surgery, Ageo Central General Hospital, Ageo, JPN.
Cureus. 2024 Nov 28;16(11):e74699. doi: 10.7759/cureus.74699. eCollection 2024 Nov.
Background Determining good candidates for head and neck cancer surgery in elderly patients requires consideration of various factors, such as overall health and social background, yet specific evaluation guidelines are lacking. The Glasgow Prognostic Score (GPS) is a marker used to assess nutritional status and prognosis in cancer patients. Objective This study aims to evaluate the association between the GPS and both the prognosis and postoperative complications in reconstructive surgery cases for head and neck cancer in patients aged 80 and over. Materials and methods A total of 22 patients aged 80 and over who underwent reconstructive surgery in our department between January 2011 and December 2023 were included. Patients were divided into three groups based on their preoperative GPS scores (0, 1, and 2 points). The overall survival was evaluated using the Kaplan-Meier method. The Cox proportional hazards model was used to analyze the association between GPS and prognosis, adjusting for confounders such as malnutrition, primary site, and comorbidities. The association between GPS and perioperative complications classified as Clavien-Dindo grade 3 or higher was also examined. Results The mean age was 82.2 years, and 20 (90%) of the subjects had comorbidities. Higher GPS scores were associated with lower survival rates, and GPS was an independent prognostic factor. There was no significant association between GPS and perioperative complications of grade 3 or higher. Conclusion The GPS is a useful prognostic indicator in elderly patients undergoing reconstructive surgery for head and neck cancer. However, a comprehensive evaluation such as the Geriatric 8, along with more inclusive malnutrition criteria, is recommended for an overall assessment of good candidates for the procedure.
背景 在老年患者中确定头颈癌手术的合适候选人需要考虑多种因素，如整体健康状况和社会背景，但缺乏具体的评估指南。格拉斯哥预后评分（GPS）是一种用于评估癌症患者营养状况和预后的指标。目的 本研究旨在评估GPS与80岁及以上头颈癌患者重建手术的预后及术后并发症之间的关联。材料与方法 纳入2011年1月至2023年12月在我科接受重建手术的22例80岁及以上患者。根据术前GPS评分（0、1和2分）将患者分为三组。采用Kaplan-Meier法评估总生存期。使用Cox比例风险模型分析GPS与预后之间的关联，并对营养不良、原发部位和合并症等混杂因素进行校正。还检查了GPS与Clavien-Dindo 3级或更高等级围手术期并发症之间的关联。结果 平均年龄为82.2岁，20例（90%）受试者有合并症。较高的GPS评分与较低的生存率相关，且GPS是一个独立的预后因素。GPS与3级或更高等级围手术期并发症之间无显著关联。结论 GPS是80岁及以上头颈癌重建手术患者有用的预后指标。然而，建议进行全面评估，如老年综合评估8项量表，并采用更具包容性的营养不良标准，以全面评估该手术的合适候选人。
