Impact of Age on Long-Term Survival in Patients with Esophageal Cancer Who Underwent Transthoracic Esophagectomy
Impact of Age on Long-Term Survival in Patients with Esophageal Cancer Who Underwent Transthoracic Esophagectomy
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DOI：
10.1159/000500604
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发表时间：
2019-01-01
期刊：
影响因子：
3.5
通讯作者：
Yano, Masahiko
中科院分区：
文献类型：
--
作者：
Motoori, Masaaki;Ito, Yuri;Yano, Masahiko
背景和目的：食道切除术是胃肠道手术中侵袭性最大的手术之一，严重影响患者的身体健康。这种恶化在老年患者中可能会很严重，高龄可能会对长期生存产生负面影响。然而，老年患者比年轻患者更有可能死于与癌症无关的原因。因此，在比较癌症手术后老年患者与年轻患者的存活率时，有必要控制癌症非相关死亡的影响。为了解决这个问题，我们计算了相对存活率，并应用超额风险模型来控制癌症死亡竞争风险的影响。方法：对505例胸段食管癌患者行经胸段食道切除术的临床资料进行回顾性分析。对所有患者的预后信息进行了随访，直至术后10年或死亡。从大阪癌症登记处的数据库中检索失访患者的预后信息。首先，我们通过单变量和多变量分析确定预后变量是年龄的混杂因素。然后，我们使用包括预测变量在内的超额风险模型作为混杂变量来估计年龄效应。结果：单因素和多因素分析显示，临床分期、肿瘤残留和术后并发症(P<；0.1)是年龄的混杂因素。多变量超额风险模型显示，在任何临界点，年龄都不是一个重要的预后因素。然而，在70岁或70岁以上的患者中，死亡的额外危险比有持续增加的趋势。结论：当临床医生为食道癌提供食道切除术时，年龄本身不应成为限制因素。术前应对患者进行严格的评估，尤其是老年人。(C)2019年S.Karger AG，巴塞尔
Background and Objective: Esophagectomy, which is one of the most invasive operations among gastrointestinal surgeries, deteriorates the physical condition of patients. Such deterioration may be severe in elderly patients and advanced age may negatively affect long-term survival. However, elderly patients are more likely to die from cancer-unrelated causes than younger patients. Therefore, when comparing the survival of elderly patients after cancer surgery with that of younger patients, it is necessary to control the influence of cancer-unrelated death. To address this problem, we calculated the relative survival and applied the excess hazard model to control the influence of competing risk of death from cancer. Methods: We retrospectively analyzed 505 patients with thoracic esophageal cancer who underwent transthoracic esophagectomy. Prognostic information was followed up to 10 years after surgery or until death in all patients. Prognostic information of patients lost to follow-up was retrieved from the Osaka Cancer Registry's database. First, we identified prognostic variables as confounders of age by univariate and multivariate analysis. Then, we estimated age effects using the excess hazard model including the prognostic variables as confounders. Results: Univariate and multivariate analysis showed that clinical stage, residual tumor, and postoperative complications (p < 0.1) were confounders of age. Multivariate excess hazard model revealed that age was not a significant prognostic factor at any cutoff point. However, the excess hazard ratio of death tended to increase continuously in patients aged 70 years or older. Conclusions: When clinicians offer esophagectomy for esophageal cancer, age per se should not be a limiting factor. Strict evaluation of patients should be performed before surgery, especially in the elderly. (C) 2019 S. Karger AG, Basel