Thomas P, Piraux M, Jacques L F, Grégoire J, Bédard P, Deslauriers J
Division of Thoracic Surgery, Laval University, Centre de Pneumologie Laval, Sainte Foy, Quebec, Canada.
Eur J Cardiothorac Surg. 1998 Mar;13(3):266-74. doi: 10.1016/s1010-7940(98)00011-6.
To investigate the clinical characteristics and determinants of operative mortality and long-term survival of elderly patients submitted to pulmonary resection for intended cure of lung cancer.
Retrospective analysis of 500 consecutive pulmonary resections performed in patients aged over 70 years from 1975 to 1996. Predictors of in-hospital mortality were identified by univariate and multivariate analyses. Determinants of long-term outcome were investigated in all survivors, with no patient being lost to follow-up.
Mean age was 74 +/- 3 years (maximum: 90), and 36 patients were octogenarians. The sex-ratio M:F was 5:3. History of combined cardiovascular or previous neoplastic disease was noted in 193 and 63 patients, respectively. The predominant histology was squamous cell carcinoma (n = 243), with a significantly higher incidence in male than in female. Most patients received standard procedures, while 103 patients underwent extended resections for tumors involving the mediastinum (n = 44), the chest wall (n = 33), the carina (n = 2) or had a sleeve resection of the main bronchus (n = 24). Procedures were considered to be complete and curative in 459 patients, among whom 294 had a stage I disease. There were 37 (7.4%) in-hospital deaths. Mortality rates following pneumonectomy, bilobectomy, lobectomy and lesser resection were 11:136, 4:34, 22:291, and 0:39, respectively. Age, male gender, hypertension, low FEV1 and extended procedure were identified as independent predictors of early mortality. Overall survival rates were 33.7 and 12% at 5 and 10 years, respectively. Multivariate analysis demonstrated that the disease stage was the main prognosticator. During the follow-up period, cancer recurrence (n = 183; 39.5%) or second primary lung cancer (n = 20; 4.3%) occurred in 203 patients, among whom 18 (9%) had a second lung resection. Carcinoma in other systems occurred in 25 patients (5.3%), and major cardiovascular event in 51 (11%).
Male and squamous cell carcinoma are characteristic of elderly patients with resected lung cancer. Operative mortality is acceptable for standard resection, and survival figures are concordant with those reported in other series which include younger patients.
探讨接受肺癌根治性肺切除术的老年患者的临床特征、手术死亡率及长期生存率的决定因素。
回顾性分析1975年至1996年期间对500例70岁以上患者连续施行的肺切除术。通过单因素和多因素分析确定院内死亡的预测因素。对所有幸存者进行长期预后决定因素的调查，无一例患者失访。
平均年龄为74±3岁（最大90岁），36例患者为八旬老人。男女比例为5:3。分别有193例和63例患者有心血管合并症或既往肿瘤病史。主要组织学类型为鳞状细胞癌（n = 243），男性发病率显著高于女性。大多数患者接受标准手术，103例患者因肿瘤累及纵隔（n = 44）、胸壁（n = 33）、隆突（n = 2）或行主支气管袖状切除术（n = 24）而接受扩大切除术。459例患者的手术被认为是完整且根治性的，其中294例为Ⅰ期疾病。有37例（7.4%）院内死亡。全肺切除术、双叶切除术、肺叶切除术和较小切除术的死亡率分别为11:136、4:34、22:291和零:39。年龄、男性、高血压、低FEV1和扩大手术被确定为早期死亡的独立预测因素。5年和10年的总生存率分别为33.7%和12%。多因素分析表明疾病分期是主要的预后因素。在随访期间，203例患者发生癌症复发（n = 183；39.5%）或第二原发性肺癌（n = 20；4.3%），其中18例（9%）接受了第二次肺切除术。其他系统发生癌症25例（5.3%），主要心血管事件51例（11%）。
男性和鳞状细胞癌是接受肺切除术的老年肺癌患者的特征。标准切除术的手术死亡率是可以接受的，生存率与其他包含年轻患者的系列报道一致。
