高龄胃癌患者术式评估及预后分析

Surgical modalities and prognosis in elderly patients with gastric cancer

目的 了解行手术治疗的高龄胃癌患者的临床病理特征、术后并发症、围手术期死亡风险及预后影响因素.方法 回顾性分析2005年1月至2009年12月于北京医院胃肠外科行胃癌根治手术的63例高龄（≥75岁）胃癌患者的临床资料.按照手术方法分为DO（未行胃周淋巴结清扫）＋D1（清扫胃周淋巴结数＞15枚）手术组（32例）和D2（清扫腹腔血管周围淋巴结数＞15枚）手术组（31例）,对两组患者的临床病理特征、术后并发症、围手术期死亡风险进行比较,并分析影响预后的因素.结果 D2手术组的淋巴结清扫数（27.42±12.75）大于D0＋D1手术组（14.59±12.11）（t=-4.095,P＜0.05）.两组并发症发生率[25.81％ （8/31）比31.25％ （10/32）,X^2=0.095,P＞0.05]及围手术期病死率[3.23％（1/31）比6.25％（2/32）,X^2=0.324,P＞0.05]差异无统计学意义.D2手术组患者5年生存率（47.3％）高于D0＋D1手术组（21.4％）,差异有统计学意义（X^2=6.346,P ＜0.05）.生理学评分（PS） ＜20分的患者5年生存率（46.3％）高于PS≥ 20分的患者（11.1％）,差异有统计学意义（X^2=5.492,P＜0.05）.PS≥20分组中,选择D2手术的患者术后并发症发生率（1/8）与D0＋D1手术患者（3/10）比较,差异无统计学意义（X^2=0.824,P＞0.05）.预后分析显示,PS ＜20分与高龄胃癌患者预后相关（X^2=5.492,P＜0.05）,淋巴结转移（OR =4.103,95％CI：1.790-9.405,P＜0.05）和D2手术（OR=0.313,95％CI：0.158- 0.620,P＜0.05）是影响高龄胃癌患者的独立预后因素.结论 标准D2根治手术在高龄患者依然是适宜的手术方式.PS ＜20分与高龄胃癌患者预后相关.淋巴结转移和D2手术是影响高龄胃癌患者的独立预后因素.

Objective To evaluate the surgical modalities and prognosis in elderly patients with gastric cancer.Methods Sixty three gastric cancer patients aged ≥≥ 75 years underwent radical surgery,with D0 ＋ D1 resection in 32 cases and D2 resection in 31 cases,in Beijing Hospital from January 2005 to December 2009.Results More lymph nodes were dissected in D2 group than those in D0 ＋ D1 group （27.42 ± 12.75 vs.14.59 ± 12.11,t =-4.095,P 〈 0.05）.There was no significant difference in postoperative complication rate [25.81% （8/31） vs.31.25% （10/32）,X^2 =0.095,P 〉 0.05] and perioperative death rate [3.23% （1/31） vs.6.25% （2/32）,X^2 =0.324,P 〉 0.05] between two groups.The 5-year survival rate was higher in D2 group than that in D0 ± D1 group （47.3% vs.21.4%,X^2 =6.346,P 〈 0.05）.The 5-year survival rate was higher in POSSUM score （PS） 〈 20 group than that in PS≥20 group （46.3% vs.11.1%,X^2 =5.492,P 〈0.05）.In PS≥20 group,postoperative complication rate did not increase after D2 radical resection（1/8 vs.3/10,X^2 =0.824,P 〉 0.05）.Univariate analysis showed that PS 〈 20 was associated with the prognosis of patients （X^2 =5.492,P 〈 0.05）.Cox proportional hazards model showed that lymph node metastasis （OR=4.103,95% CI：1.790-9.405,P 〈 0.05） and D2 radical gastrectomy（OR =0.313,95% CI：0.158-0.620,P 〈 0.05） were the independent factors associated with the prognosis of patients aged ≥ 75 years with gastric cancer （all P 〈 0.05）.Conclusion Standardized D2 lymph node dissection is beneficial for gastric cancer patients aged ≥75 years.PS 〈 20,lymph node metastasis and D2 radical gastrectomy are associated with the prognosis of patients.