Mortality calculator as a possible prognostic predictor of overall survival after gastrectomy in elderly patients with gastric cancer.
Mortality calculator as a possible prognostic predictor of overall survival after gastrectomy in elderly patients with gastric cancer.
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DOI：
10.1186/s12957-020-02052-x
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发表时间：
2020-10-30
影响因子：
3.2
通讯作者：
Ichikawa D
中科院分区：
文献类型：
--
作者：
Akaike H;Kawaguchi Y;Maruyama S;Shoda K;Saito R;Furuya S;Hosomura N;Amemiya H;Kawaida H;Sudoh M;Inoue S;Kohno H;Ichikawa D
老年胃癌患者数量不断增加。大多数老年患者的生理功能下降，有时可能成为安全手术治疗的障碍。国家临床数据库风险计算器基于日本大型手术数据库，提供每种情况下的预测死亡率和发病率作为手术相关风险。本研究的目的是探讨老年胃癌患者胃切除术后长期随访期间，通过国家临床数据库风险计算器计算的手术死亡风险（NRC-mortality）的临床意义。我们招募了 73 名年龄≥ 80 岁的患者，并在我们的机构接受了胃切除术。他们的手术风险是根据 NRC 死亡率进行评估的。选择并分析了一些临床病理因素，包括 NRC 死亡率，作为因胃癌接受胃切除术的老年患者的可能预后因素。使用对数秩检验和Cox比例风险模型进行统计分析。 NRC 死亡率范围为 0.5% 至 10.6%，中值为 1.7%。根据死亡率对患者进行分组，高死亡率组（≥ 1.7%，n = 38）的总生存率显着低于低死亡率组（< 1.7%，n = 35），而两组之间的疾病特异性生存率没有差异。在 Cox 比例风险模型中，多变量分析显示 NRC 死亡率、体能状态和手术程序是总体生存的独立预后因素。对于疾病特异性生存，独立的预后因素是体能状态和病理阶段，但不是 NRC 死亡率。 NRC 死亡率在临床上可能有助于预测老年胃癌患者胃切除术后的手术死亡率和总生存率。
The number of elderly patients with gastric cancer has been increasing. Most elderly patients have associated reduced physiologic functions that can sometimes become an obstacle to safe surgical treatment. The National Clinical Database Risk Calculator, which based on a large Japanese surgical database, provides predicted mortality and morbidity in each case as the surgical-related risks. The purpose of this study was to investigate the clinical significance of the risk for operative mortality (NRC-mortality), as calculated by the National Clinical Database Risk Calculator, during long-term follow-up after gastrectomy for elderly patients with gastric cancer. We enrolled 73 patients aged ≥ 80 years and underwent gastrectomy at our institution. Their surgical risk was evaluated based on the NRC-mortality. Several clinicopathologic factors, including NRC-mortality, were selected and analyzed as the possible prognostic factors for elderly patients who have undergone gastrectomy for gastric cancer. Statistical analysis was performed using the log-rank test and Cox proportional hazard model. NRC-mortality ranged from 0.5 to 10.6%, and the median value was 1.7%. Dividing the patients according to mortality, the overall survival was significantly worse in the high mortality group (≥ 1.7%, n = 38) than in the low mortality group (< 1.7%, n = 35), whereas disease-specific survival was not different between the two groups. In the Cox proportional hazard model, multivariate analysis revealed NRC-mortality, performance status, and surgical procedure as the independent prognostic factors for overall survival. For disease-specific survival, the independent prognostic factors were performance status and pathological stage but not NRC-mortality. The NRC-mortality might be clinically useful for predicting both surgical mortality and overall survival after gastrectomy in elderly patients with gastric cancer.
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