外科治疗70岁以上老年肺癌患者的预后因素分析

Prognostic factors for survival after lung cancer surgery in elderly patients

背景与目的随着手术和麻醉技术的提高,越来越多的老年肺癌患者接受手术治疗。本研究的目的是探讨70岁以上老年肺癌患者术后生存情况及其影响因素,为老年肺癌的治疗提供依据。方法回顾性分析192例手术治疗的70岁以上老年肺癌患者的术后生存情况,采用单因素和多因素方法分析各种预后因素的影响度。结果全组总的5年生存率为33.5%。手术方式、手术性质、病理类型及分期均可显著影响患者的预后,其中后三者为独立预后因素。结论老年肺癌患者术前应全面检查,尽量避免单纯探查手术和姑息手术。手术以肺叶切除为标准术式,某些特殊情况下,也可行部分肺叶切除术。

Background and objective With the improvement of the surgical and anesthetic techniques, there are increasing numbers of elderly surgical patients with lung cancer. The purpose of this study is to examine the prognostic factors of surgical resection in patients more than 70 years of age. Methods Data were retrospectively analyzed from 192 patients aged 370 years who underwent lung cancer surgery. Of these patients, 48.4% were in stage Ⅰ , 20.8% in stage Ⅱ, 19.3% in stage Ⅲ, and 2.1% in stage Ⅳ. Patient demographics were the following： 79.2% male and 20.8% female; 21.9% 375 years older; and 11.5% had significant co-morbidities. Tumor characteristics： squamous cell carcinoma 49.0%, adenocarcinoma 35.9%, adenosquamous carcinoma 8. 3%, small cell lung cancer 4. 7%, others 2. 1%. Operations： exploration 2. 1%, wedge resection 8.3%, lobectomy 72.4%, more than lobectomy 12.5%, pneumonectomy 4. 7%. Of these operations, 91.1% were radical surgery. The significance of prognostic factors was assessed by univariate and multivariate COX regression analyses. Results The total 5-year survival rate was 33.5 % in this series. Age, sex, symptom and co-morbidity had no impact on survival. Multivariable COX analysis demonstrated that incomplete resection （P=0. 003）, advanced surgical-pathological stage （P〈0. 001） and other type of the tumor （P=0. 016） were significant, independent, unfavorable prognostic determinants in patients. Conclusion Thoracic surgery is a safe and feasible approach in elderly patients with lung cancer. Every effort should be made to detect early stage patients who might benefit from surgical treatment. Lobectomy is still the ideal surgical op- tion for elderly patients who are able to tolerate the procedure. More limited lung surgery may be an adequate alternative in patients with associated co-morbidities.