老年晚期上皮性卵巢癌患者术后早期严重并发症发生的相关因素分析

Analysis of factors for serious early complications after primary debulking surgery in elderly patients with advanced epithelial ovarian cancer

目的探讨接受初始肿瘤细胞减灭术(PDS)的老年晚期上皮性卵巢癌(EOC)患者术后30d内严重并发症发生的相关因素。方法回顾性分析2014年1月至2018年12月于中国医学科学院肿瘤医院妇瘤科及国家老年医学中心北京医院妇科接受PDS的年龄≥60岁的国际妇产科联盟(FIGO)分期ⅢC/Ⅳ期上皮性卵巢癌患者的临床资料,采用Clavien-Dindo评分系统对术后30d内发生的并发症进行分级,Ⅲ级及以上并发症为术后早期严重并发症。采用多因素Logistic回归分析探讨术后30d内严重并发症的独立危险因素。结果本研究共纳入133例患者,术后严重并发症发生率11.3%(15/133)。严重并发症组患者平均年龄明显高于对照组[(69.80±6.56)岁比(65.87±5.14)岁,t=2.699,P=0.008]。严重并发症组术前ECOG评分≥2分患者比例高于对照组[26.7%(4/15)比5.9%(7/118),χ^(2)=4.985,P=0.026],低白蛋白血症(<35g/L)比例高于对照组[20.0%(3/15)比3.4%(4/118),χ^(2)=4.897,P=0.027]。两组患者手术相关指标术中出血量、R0切除率及手术复杂度差异均无统计学意义(χ^(2)=1.964、0.330、4.637,均P>0.05)。多因素Logistic回归分析结果显示,发生术后早期严重并发症的独立相关因素为:年龄≥70岁(OR=4.345、P=0.028)、ECOG评分≥2分(OR=25.619、P=0.008)和术前白蛋白<35g/L(OR=6.733、P=0.040)。结论在老年卵巢癌患者中,应加强对存在术后早期严重并发症相关因素患者的个体化围术期管理,以期减少并发症,改善预后。

Objective To investigate the factors for serious complications within 30 days after surgery in elderly patients with advanced epithelial ovarian cancer(EOC)who undertook primary debulking surgery(PDS).Methods The clinical data of International Federation of Gynecology and Obstetrics(FIGO)stage ⅢC/Ⅳ EOC patients aged≥60 years who received PDS in gynecological department of National Cancer Center and National Center of Gerontology between January 2014 and December 2018 were retrospectively analyzed.Clavien-Dindo scoring system was applied to grade the complications within 30 days after surgery.The serious early postoperative complications were those of grade Ⅲ or above occurred within 30 days after surgery.Multivariate Logistic regression analysis was used to screen the independent risk factors of serious complications within 30 days after surgery.Results A total of 133 patients were included in this study and serious complications rated 11.3%(15/133).The mean age of patients in severe complication group was significantly higher than that in the control group[(69.80±6.56)vs.(65.87±5.14),t=2.699,P=0.008].The proportion of patients with preoperative ECOG score≥2 was significantly higher in the severe complication group than that in the control group[26.7%(4/15)vs.5.9%(7/118),χ^(2)=4.985,P=0.026],and the proportion of preoperative hypoalbuminemia(<35 g/L)was significantly higher in the severe complication group[20.0%(3/15)vs.3.4%(4/118),χ^(2)=4.897,P=0.027].However,there was no significant difference in intraoperative bleeding,RO resection rate as well as surgical complexity(χ^(2)=1.964,0.330,4.637,all P>0.05)between the two groups.Multivariate Logistic regression analysis showed that the independent factors for serious early postoperative complications were age≥70 years(OR=4.345,P=0.028),ECOG score≥2(OR=25.619,P=0.008)and preoperative albumin<35 g/L(OR=6.733,P=0.040).Conclusions In the elderly ovarian cancer patients,individualized perioperative management should be strengthened for the patients with factors associated with serious early postoperative complications,in order to reduce severe complications and improve the prognosis.