Izumo Wataru, Kawaida Hiromichi, Saito Ryo, Nakata Yuki, Amemiya Hidetake, Higuchi Yudai, Nakayama Takashi, Takahashi Kazunori, Maruyama Suguru, Takiguchi Koichi, Shoda Katsutoshi, Shiraishi Kensuke, Furuya Shinji, Kawaguchi Yoshihiko, Ichikawa Daisuke
Department of Digestive Surgery, University of Yamanashi Hospital, 1110 Shimokato, Chuo-shi, Yamanashi, 409-3898, Japan.
Langenbecks Arch Surg. 2025 Apr 3;410(1):119. doi: 10.1007/s00423-025-03694-9.
This retrospective study investigated the validity of pancreatoduodenectomy (PD) with regard to recurrence in older patients with distal cholangiocarcinoma (DC).
We compared 28 patients aged ≥ 75 years and 65 patients aged < 75 years who underwent PD for DC, and evaluated the relationship between age, clinicopathological factors, and outcomes.
Postoperative mortality and morbidity rates did not differ between the groups. Although there were no significant differences in 5-year recurrence, disease-specific survival, and overall survival rates between the groups (45.4, 58.1, and 51.7% in patients ≥ 75 years and 50.3%, 62.7%, and 58.1% in patients < 75 years; P = 0.73, 0.44, and 0.24, respectively), the median time from recurrence to death (RTD) in older patients was significantly shorter than that in younger patients (0.5 years vs. 1.3 years, P = 0.013). In multivariate analysis, age ≥ 75 years (hazard ratio [HR]: 3.0), controlling nutritional status (CONUT) score ≥ 4 (HR: 2.5), poorly-differentiated adenocarcinoma or adenosquamous carcinoma (HR: 3.2), and failure to implement treatment after recurrence (HR: 5.3) were independent risk factors for a short time from RTD. Furthermore, at the time of recurrence, older patients had significantly poorer serum albumin levels, prognostic nutrition index, Glasgow prognostic score, and CONUT score. Age ≥ 75 years (odds ratio: 0.19) was an independent risk factor for implementation of treatment after recurrence.
PD in older patients may be acceptable; however, the median time from RTD was shorter owing to lower nutritional status and rates of treatment implementation after recurrence.
这项回顾性研究调查了胰十二指肠切除术（PD）对老年远端胆管癌（DC）患者复发情况的有效性。
我们比较了28例年龄≥75岁和65例年龄<75岁接受PD治疗DC的患者，并评估了年龄、临床病理因素和预后之间的关系。
两组患者术后死亡率和发病率无差异。尽管两组患者的5年复发率、疾病特异性生存率和总生存率无显著差异（≥75岁患者分别为45.4%、58.1%和51.7%，<75岁患者分别为50.3%、62.7%和58.1%；P分别为0.73、0.44和0.24），但老年患者从复发到死亡的中位时间（RTD）明显短于年轻患者（0.5年对1.3年，P = 0.013）。多因素分析显示，年龄≥75岁（风险比[HR]：3.0）、控制营养状况（CONUT）评分≥4（HR：2.5）、低分化腺癌或腺鳞癌（HR：3.2）以及复发后未进行治疗（HR：5.3）是RTD时间短的独立危险因素。此外，复发时老年患者的血清白蛋白水平、预后营养指数、格拉斯哥预后评分和CONUT评分明显较差。年龄≥75岁（优势比：0.19）是复发后进行治疗的独立危险因素。
老年患者行PD可能是可接受的；然而，由于营养状况较差和复发后治疗实施率较低，RTD的中位时间较短。
