老年食管癌患者术后远近期疗效分析

Analysis of short-and long-term outcomes after esophagectomy in elderly cancer patients

目的:通过比较不同年龄段老年食管癌患者的术前合并症、术后并发症和远近期生存率等情况,评估老年食管癌患者的近远期疗效。方法:回顾性分析2010年1月至2010年12月中国科学技术大学附属第一医院连续行根治性食管癌手术的患者253例。根据年龄将其分为A组(年龄<60岁)、B组(60~75岁)和C组(年龄≥75岁),比较分析3组患者远近期疗效。结果:3组患者在合并高血压病方面,差异具有统计学意义(P<0.05)。3组术后总并发症、主要并发症、肺部感染、心律失常、呼吸功能不全方面,差异具有统计学意义(P<0.05),而在术后吻合口瘘和其他并发症方面,差异无统计学意义(P>0.05)。平均随访时间为50.7个月,A组患者中位生存期和1、3、5年总生存率(overall survival,OS)分别为68个月、98.9%、86.8%和69.0%,B组为61个月、93.1%、76.1%和51.0%,C组为32个月、63.3%、46.0%和28.8%(P<0.001)。A组中位无进展生存期和1、3、5年无进展生存率(progression free survival,PFS)分别为60个月、98.86%、85.20%和45.50%,B组为43个月、87.6%、53.1%和26.9%,C组为11个月、30.0%、20.0%和10.0%。A组分别与B、C组比较、B组与C组相比较生存率差异均具有统计学意义(P<0.001)。多因素分析显示,影响患者OS和PFS的独立危险因素为高龄和Ⅳ期肿瘤患者(P<0.05)。结论:老年食管癌患者术后远期生存率下降。年龄和肿瘤病理分期偏晚是影响食管癌患者远期预后的独立危险因素。

Objective： To analyze the short- and long-term outcomes of elderly patients after esophagectomy by comparing preoperative comorbidities, postoperative complications, and survival rates among different age groups. Methods： We retrospectively reviewed the data of 253 patients who underwent esophagectomy from January to December 2010 in The First Affiliated Hospital of University of Science and Technology of China. Eighty-eight （34.8%） patients were aged 〈60 years （group A）, 145 （57.3%） were aged 60-75 years （group B）, and 20 （7.9%） were aged ≥75 years （group C）. The short- and long-term outcomes of the patients were analyzed. Results： There were significant differences in three group of patients with hypertension before operation （P〈0.05）. There were statistically significant differences among all complications, major complications, pulmonary infection, arrhythmia, and respiratory insufficiency （P〈 0.05）, except for anastomotic leakage and other complications （P〉0.05）. The mean follow-up was 50.7 months. The median overall survival and 1-, 3-, and 5-year overall survival rates were 68 months and 98.9%, 86.8%, and 69%, respectively, for group A; 61 months and 93.1%, 76.1%, and 51%, respectively, for group B; and 32 months and 63.3%, 46%, and 28.8%, respectively, for group C （P〈0.001）. The median progression-free survival （PFS） and 1-, 3-, and 5-year PFS rates were 60 months and 98.86%, 85.2%, and 45.5%, respectively, for group A; 43 months and 87.6%, 53.1%, and 26.9%, respectively, for group B; and 11 months and 30%, 20%, and 10%, respectively, for group C （P〈0.001）. The differences in survival rates between groups A and B, A and C, and B and C were statistically significant （P〈 0.001）. The multivariate analysis showed that age and TNM stage IV were independent risk factors for overall survival and PFS （P〈 0.05）. Conclusions： The long-term survival rate decreases significantly in elderly patients with esophageal cancer. In addition, age and advanced pathological stage of tumor are independent risk factors for long-term outcomes.