高龄、超高龄胃癌患者胃根治术后疗效分析

Analysis of Curative Effect after Radical Gastrectomy in Early-elderly Patients and Late-elderly Patients with Gastric Cancer.

目的探讨高龄、超高龄胃癌患者根治性胃切除术后的临床病理特征、近期并发症和预后情况。方法回顾性分析2010年1月-2017年1月544例接受胃癌根治性切除术的患者的临床资料,将患者分为老年组(60-64岁,n=358)、高龄组(75-79岁,n=118)、超高龄组(≥80岁,n=68),以老年组为对照组,高龄组及超高龄组为试验组,比较其临床病理特征、围术期病死率、术后并发症及术后生存情况。结果超高龄组合并症数目较老年组多(P=0.000),肿瘤以>5cm为多见(P=0.000),手术切除范围以远端胃切除术为主(P=0.042),预后营养指数(prognostic nutritional index,PNI)较低(P=0.036),术后总体并发症及严重并发症发生率均高于老年组(P=0.000,P=0.034),主要以术后肠梗阻和术后肺炎为多见(P=0.031;P=0.003);高龄组合并症数目也较老年组多(P=0.000),肿瘤平均直径为5.20±2.96cm(P=0.014),手术时间较老年组短(P=0.047),术后总体并发症发生率较高(P=0.019)。超高龄组、高龄组患者与老年组比较,围术期病死率差异均无统计学意义(P=0.068;P=0.408)。在Ⅰ、Ⅱ、Ⅲ期胃癌患者中,高龄组、超高龄组的3年总生存期均较老年组低,但疾病特异生存期比较差异无统计学意义。结论高龄及超高龄患者因生理功能的恶化,胃根治术后多死于除胃癌复发以外的其他原因,对于以上患者来说,需谨慎考虑治疗的侵袭性与预后之间的平衡。

Objective To compare the clinicopathological features,short-term complications and long-term survival of early-elderly patients and late-elderly patients with gastric cancer after radical gastrectomy.Methods Clinical data of 544 patients who underwent radical gastrectomy for gastric cancer from January 2010 to January 2017 were retrospectively analyzed,and the patients were divided into the elderly group(60-64 years,n=358),early-elderly group(75-79 years,n=118),late-elderly group(≥80 years,n=68).the elderly group was used as the control group,and early-elderly group and late-elderly group were used as the experimental groups.The clinicopathological characteristics,perioperative mortality,postoperative complications and postoperative survival were compared.Results The number of complications in the late-elderly group was more than that in the elderly group(P=0.000),the tumor diameter is bigger than 5cm(P=0.000),distal gastrectomy were the main surgical resection range(P=0.042),and prognostic nutritional index(PNI)was lower(P=0.036).The incidence of total and severe postoperative complications was higher than that in the elderly group(P=0.000,P=0.034),mainly postoperative intestinal obstruction and postoperative pneumonia(P=0.031,P=0.003).The number of comorbidities in the elderly group was also higher than that in the elderly group(P=0.000),the mean tumor size was 5.20±2.96cm(P=0.014),the operative time was shorter than that of the elderly group(P=0.047),and the overall incidence of postoperative complications was higher(P=0.019).There was no significant difference in perioperative mortality between the early-elderly group,late-elderly group and the elderly group(P=0.068,P=0.408).In the patients with stageⅠ,ⅡandⅢgastric cancer,the 3-year overall survival time of the early-elderly group and late-elderly group was lower than that of the elderly group,but the disease-specific survival time had no significant difference.Conclusion Due to the deterioration of physiological function,most early-elderly and late-elderly patients die of other causes besides recurrence of gastric cancer after radical gastrectomy.For these patients,it is necessary to carefully consider the balance between the aggressiveness of treatment and prognosis.