65岁及以上胃肠恶性肿瘤患者10135例择期手术后不良结局的影响因素分析  

Analysis of risk factors for adverse outcomes in 10,135 patients with gastrointestinal malignancies aged 65 years and over who underwent elective surgery

作　　者：王薇[1] 王敬普 王丹[1] 蔡鸿圳 吴舟桥[1] 陕飞[1] 李子禹[1] Wang Wei;Wang Jingpu;Wang Dan;Cai Hongzhen;Wu Zhouqiao;Shan Fei;Li Ziyu(Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education),Peking University Cancer Hospital&Institute,Beijing100142,China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所,北京100142

出　　处：《中华胃肠外科杂志》2024年第11期1155-1161,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：北京大学临床医学+X青年项目(PKU2022LCXQ038);海淀区卫生健康发展科研培育计划(HP2023-19-503001)。

摘　　要：目的探索老年肿瘤患者术后不良结局的影响因素,为老年患者手术筛选和评估提供参考依据。方法采用描述性观察性研究的方法。选取北京大学肿瘤医院2008—2022年期间择期手术的65岁及以上老年胃肠恶性肿瘤患者作为研究对象,调查分析对比各个年龄段老年胃肠肿瘤患者的临床特征(病种、肿瘤分期)、手术安全性(是否联合脏器切除、手术时长和手术合并症等)及其是否出现不良结局(包括术后并发症、非计划二次手术和围手术期院内死亡等),采用多因素logistic回归分析影响患者不良结局的危险因素。结果共计10135例患者纳入分析。其中65~75岁(不含75岁,低龄老年组)74.7%(7568例),75~85岁(不含85岁,高龄老年组)23.6%(2391例),≥85岁(超高龄老年组)1.7%(176例)。病种数据显示,10135例患者中,结直肠癌占比63.4%(6427例),高于胃癌的36.6%(3708例)。全组肿瘤Ⅱ~Ⅲ期者占62.0%(6284/10135),154例超高龄老年组中Ⅲ期和Ⅳ期肿瘤占比[47.4%(73例)和11.0%(17例)]高于2051例高龄老年组中的41.6%(854例)和8.2%(168例)]以及6431例低龄老年组中的40.1%(2576例)和10.9%(700例),组间比较差异有统计学意义(χ^(2)=27.95,P<0.01)。全组有合并症者占比为50.6%(5128/10135),超高龄老年组合并症占比58.0%(102/176),高于高龄老年组的56.3%(1346/2391)和低龄老年组的48.6%(3678/7568),差异均有统计学意义(均P<0.05)。合并症以高血压、糖尿病、心脑血管疾病为主(占比分别为37.3%、16.4%和14.0%)。全组微创手术占比36.9%(3740/10135),低龄老年组占比(38.4%)高于高龄老年组(32.5%)和超高龄老年组(29.0%),3组比较差异有统计学意义(χ^(2)=31.97,P<0.01)。术前新辅助治疗者9.1%(924/10135),低龄老年组占比(11.1%)高于高龄老年组(3.4%)和超高龄老年组(0.6%),3组比较差异有统计学意义(χ^(2)=148.98,P<0.01)。联合脏器切除占比4.9%(496/10135),超高龄老年组占比(2.3%)低于低龄老年组(5.3Objective To explore the risk factors for postoperative adverse events in older persons with gastrointestinal malignancies and thus provide reference for selection of surgery and evaluation of such patients.Methods An observational study design was employed,the study cohort comprising patients aged 65 years and over with gastrointestinal malignancies who underwent elective surgery in Peking University Cancer Hospital from 2008 to 2022.In this study,we compared the clinical characteristics(disease type,tumor stage),surgical safety(combined organ resection,operation duration,comorbidities),and treatment outcomes(postoperative complications,unplanned reoperation,and perioperative mortality)of these patients.Multivariate logistic regression analysis was conducted to identify risk factors associated with adverse outcomes.Results The study cohort comprised 10,135 patients,of whom 74.7%(7,568)were 65–75 years old(excluding 75 years old),23.6%(2,391)75–85 years old(excluding 85 years old),and 1.7%(176)≥85 years old.The type of cancer was colorectal in 63.4%(6,427 patients)and gastric in 36.6%(3,708);62.0%(6,284/10,135)of the patients had stage II or III disease.The proportion of stage III and stage IV tumors was higher in patients aged over 85 years(47.4%[73/154)and 11.0%[17/154]),respectively,than in those aged 75–85 years(41.6%[854/2051)and 8.2%[168/2051]),respectively,and those aged 65–75 years(40.1%[2,576/6,431)and 10.9%[700/6,431]);these differences are statistically significant(χ^(2)=27.95,P<0.01).Comorbidity was present in 50.6%(5,128/10,135)of the whole study cohort,comprising 58.0%(102/176)of those aged over 85 years,this being significantly higher than the 56.3%(1,346/2,391)in those aged 75–85 years and 48.6%(3,678/7,568)of those aged 65–75 years.The main comorbidities were hypertension(37.3%),diabetes(16.4%),and cardiovascular and cerebrovascular diseases(14.0%).Minimally invasive surgery was performed on 36.9%(3,740/10,135)of the whole study cohort,the 38.4%in 65–75 years old patients being s

关 键 词：胃肠恶性肿瘤 老年患者 手术 术后不良事件 

分 类 号：R735[医药卫生—肿瘤]