高龄非小细胞肺癌患者的手术治疗及预后

目的比较年轻和高龄非小细胞肺癌（NSCLC）患者的临床基本特征与生存率，探讨高龄患者围手术期的处理特点。方法根椐上海市疾病预防与控制中心数据统计，选取我院2002年1～12月手术的178例非小细胞肺癌患者的临床资料，依据年龄分为年轻组（〈50岁，89例）和高龄组（〉70岁，89例）。回顾性分析两组患者相关临床指标、手术方式、术后并发症，用Kaplan—Meier法进行生存率计算。结果高龄组患者中鳞状细胞癌比例高于年轻组（Х^2=9．281，P=0．000），而性别、吸烟人数、病理类型、TNM分期、手术方式、术后放化疗等临床特征及分布差异无统计学意义（Х^2≤5．569，P〉0．05）。术前合并心血管疾病、慢性支气管炎者高龄组高于年轻组（Х^2=14．053，13．044，P=0．000），术后并发症发生率高龄组高于年轻组（Х^2=12．842，P=0．000）；高龄组术后1、3、5年生存率分别为71．43％，33．53％和27．83％；年轻组分别为77．78％，46．67％和44．07％，两组比较差异无统计学意义（P〉0．05）。结论高龄非小细胞肺癌患者术后风险相对较高，应加强围手术期的处理，手术可获得与年轻患者接近的长期生存率，仍是值得首选的治疗方式。

The Surgical Treatment and Prognosis in Elderly with Non-small Cell Lung Cancer

Objective To determine whether the basal characteristics and survival of young patients undergoing surgical resection of non-small cell lung cancer （NSCLC） differ from those of elderly patients. And, we would discuss the special perioperative management in elderly patients with NSCLC. Methods 178 NSCLC patients who underwent surgery in our hospital between Jan. to Dec. in 2002 were divided into two groups according to age. Young group comprised 89 patients aged 50 years or younger and elderly group comprised 89 patients aged 70 years or older. The patients＇ clinical data, operative style, postoperative complications and survival results were reviewed and analysed. Results The proportion of the elderly group squamous cell carcinoma patients was higher than that of the younger group （Х^2= 9.281, P = 0. 000. ）, but there was no significant difference between the gender, smoking, histology, TNM stage, type of resection, post operation chemotherapy or radiotherapy （Х^2≤ 5. 569, P〉0.05）. The incidence of the preoperative cardiovascular disease, chronic bronchitis in the elderly group patients were higher than those of younger group（Х^2= 14. 053, P = 0. 000 ; Х^2 = 13. 044, P = 0. 000）. The incidence of postoperative complications was significantly higher in elderly group than those of younger group（Х^2 = 12. 842,P= 0. 000）. The 1, 3 and 5-year survival rates were 71. 43%,33.53% and 27.83% in elderly group, and 77.78%,46.67% and 44.07% in young group, respectively. However, the 1, 3 and 5 year survival rates for patients in two groups showed no difference between two groups（P〈 0.05）. Conclusion The elderly patients have higher operative risk than that of young patients. We should pay more attention to the perioperative management of elderly patients. The elderly patients could get acceptable long term survival rates through surgical treatment. Operation is still the first choice for elderly patients with NSCLC.