AIM:To elucidate the prognostic value of age for gastric cancer and identify the optimal treatment for elderly gastric cancer patients.METHODS:We enrolled 920 patients with gastric cancer who underwent gastrectomy bet...AIM:To elucidate the prognostic value of age for gastric cancer and identify the optimal treatment for elderly gastric cancer patients.METHODS:We enrolled 920 patients with gastric cancer who underwent gastrectomy between January 2003and December 2007 in our center.Patients were categorized into three groups:younger group(age<50years),middle-aged group(50-69 years),and elderly group(≥70 years).Clinicopathological features were compared among the three groups and potential prognostic factors were analyzed.The log-rank test was used to assess statistical differences between curves.Independent prognostic factors were identified by the Cox proportional hazards regression model.Stratified analysis was used to investigate the impact of age on survival at each stage.Cancer-specific survival was also compared among the three groups by excluding deaths due to reasons other than gastric cancer.We analyzed the potential prognostic factors for patients aged≥70years.Finally,the impact of extent of lymphadenectomy and postoperative chemotherapy on survival for each age group was evaluated.RESULTS:In the elderly group,there was a male predominance.At the same time,cancers of the upper third of the stomach,differentiated type,and less-invasive surgery were more common than in the younger or middle-aged groups.Elderly patients were more likely to have advanced tumor-node-metastasis(TNM)stage and larger tumors,but less likely to have distant metastasis.Although 5-year overall survival(OS)rate specific to gastric cancer was not significantly different among the three groups,elderly patients demonstrated a significantly lower 5-year OS rate than the younger and middle-aged patients(elderly vs middle-aged vs younger patients=22.0%vs 36.6%vs 38.0%,respectively).In the TNM-stratified analysis,the differences in OS were only observed in patients withⅡandⅢtumors.In multivariate analysis,only surgical margin status,pT4,lymph node metastasis,M1 and sex were independent prognostic factors for elderly patients.The5-year OS rate did not differ between elderly patients undergoing D1 and D2 lymph node resection,and these patients benefited little from chemotherapy.CONCLUSION:Age≥70 years was an independent prognostic factor for gastric cancer after gastrectomy.D1 resection is appropriate and postoperative chemotherapy is possibly unnecessary for elderly patients with gastric cancer.展开更多
基金Supported by National Basic Research Program of China: 973 Program, No. 2010CB529301
文摘AIM:To elucidate the prognostic value of age for gastric cancer and identify the optimal treatment for elderly gastric cancer patients.METHODS:We enrolled 920 patients with gastric cancer who underwent gastrectomy between January 2003and December 2007 in our center.Patients were categorized into three groups:younger group(age<50years),middle-aged group(50-69 years),and elderly group(≥70 years).Clinicopathological features were compared among the three groups and potential prognostic factors were analyzed.The log-rank test was used to assess statistical differences between curves.Independent prognostic factors were identified by the Cox proportional hazards regression model.Stratified analysis was used to investigate the impact of age on survival at each stage.Cancer-specific survival was also compared among the three groups by excluding deaths due to reasons other than gastric cancer.We analyzed the potential prognostic factors for patients aged≥70years.Finally,the impact of extent of lymphadenectomy and postoperative chemotherapy on survival for each age group was evaluated.RESULTS:In the elderly group,there was a male predominance.At the same time,cancers of the upper third of the stomach,differentiated type,and less-invasive surgery were more common than in the younger or middle-aged groups.Elderly patients were more likely to have advanced tumor-node-metastasis(TNM)stage and larger tumors,but less likely to have distant metastasis.Although 5-year overall survival(OS)rate specific to gastric cancer was not significantly different among the three groups,elderly patients demonstrated a significantly lower 5-year OS rate than the younger and middle-aged patients(elderly vs middle-aged vs younger patients=22.0%vs 36.6%vs 38.0%,respectively).In the TNM-stratified analysis,the differences in OS were only observed in patients withⅡandⅢtumors.In multivariate analysis,only surgical margin status,pT4,lymph node metastasis,M1 and sex were independent prognostic factors for elderly patients.The5-year OS rate did not differ between elderly patients undergoing D1 and D2 lymph node resection,and these patients benefited little from chemotherapy.CONCLUSION:Age≥70 years was an independent prognostic factor for gastric cancer after gastrectomy.D1 resection is appropriate and postoperative chemotherapy is possibly unnecessary for elderly patients with gastric cancer.
文摘目的探讨奥沙利铂术前化疗对老年胃肠道肿瘤患者术后认知功能障碍(postoperative cognitive dysfunction,POCD)的影响。方法选取择期全凭静脉麻醉下行胃癌、结肠癌或直肠癌根治术的老年患者100例,根据术前有无奥沙利铂化疗史分为术前化疗组(PC组)和非化疗组(NC组),每组50例;同时招募25名老年志愿者为对照组(C组),采用神经心理学测试评估认知功能,观察PC组和NC组患者术后第7天POCD发生情况,多因素Logistic回归分析其发生的独立危险因素。结果 PC组46例、NC组48例和C组25名志愿者均完成所有神经心理学测试。与C组第8天神经心理学测试结果比较,PC组和NC组术后7 d视觉-语言学习测试(包括瞬时和延迟记忆)及数字-符号编码测试评分明显下降,寻迹连线测试和斯特普色词测试完成时间明显延长(P<0.05)。与NC组比较,PC组术后7 d视觉-语言学习测试(瞬时记忆)和数字-符号编码测试评分明显降低(P<0.05)。PC组POCD发生率高于NC组(45.7% vs 25.0%,P<0.05),术后住院时间亦明显延长(P<0.05)。多因素Logistic回归分析结果显示,年龄(≥75岁)和奥沙利铂术前化疗是术后7 d POCD发生的独立危险因素。结论奥沙利铂术前化疗可导致老年胃肠道肿瘤患者POCD发生率升高,延长术后住院时间。
