Mortality within 30 Days for Patients Older than 70 Years Receiving Chemotherapy: a Single-institution Retrospective Analysis
RB Goody, ES Choong, J Calderwood, SJM Law, G Mazdai, GG Hanna, JJA McAleer
Hong Kong J Radiol 2010;12:95-102
Objective: The average life expectancy in western populations is increasing, as is the incidence of malignancy in older people. Historically, most chemotherapy clinical trials exclude patients older than 70 years from enrolment, so information on complications and outcomes is sparse. This study examined mortality rates within 30 days of administration of chemotherapy to patients older than 70 years in routine clinical practice.
Methods: The medical records of all patients older than 70 years who received chemotherapy at the Cancer Centre, Belfast City Hospital, Belfast, UK, during 2006 were retrospectively reviewed. Patients’ baseline demographics, characteristics, treatment, complications, death occurring within 30 days of chemotherapy, and overall survival were recorded. Actuarial survival was estimated using the Kaplan-Meier method.
Results: 284 patients were enrolled. The median age was 74 years (range, 70-88 years). The most frequent tumour sites were colorectal (25.0%), lung (22.2%), ovary (12.0%), and oesophagus (11.3%). Median survival was 17.7 months for all patients (95% confidence interval, 14.4-20.9 months) and 12.1 months for patients receiving palliative chemotherapy (95% confidence interval, 9.7-14.5 months; n = 182); median survival has not been reached for patients receiving neo-adjuvant, radical, or adjuvant chemotherapy (n = 102). Mortality within 30 days was 3.5% (n = 10). All patients who died were receiving palliative chemotherapy (5.5% of all palliative patients) and 1 death was treatment related.
Conclusions: These results compare favourably with previously published non–clinical trial outcome data for similar age groups. Further investigation is required regarding the optimal assessment and management of elderly patients receiving chemotherapy.
中文摘要
70歲以上患者在化療後30天內的死亡率：一個單一機構的回顧性分析
RB Goody, ES Choong, J Calderwood, SJM Law, G Mazdai, GG Hanna, JJA McAleer
目的：隨著西方人口的平均預期壽命增加，老年人的惡性腫瘤發病率也在上升。以往，大多數有 關化療的臨床試驗的病人招收均沒有包括70歲以上的病人，因此其化療併發症及化療效果的資訊很 少。本項研究將調查70歲以上病人在日常臨床治療時實施化療後三十天內的死亡率。
方法：回顧性分析英國貝爾法斯特市立醫院癌症中心2006年70歲以上所有老年腫瘤病人的病歷。記錄病人的基本統計資料，特徵，治療，併發症，化療開始30天內死亡及整體生存期。統計生存期用 Kaplan-Meier評估。
結果：共284名病人入選，中位年齡為74歲(範圍：70-88歲)。最常見腫瘤部位為大腸直腸(25.0%)， 肺(22.2%)，卵巢(12.0%)及食道(11.3%)。所有病人中位生存期為17.7個月(95%可信區間：14.4-20.9 個月)，接受緩解化療的病人的中位生存期為為12.1個月(95%可信區間：9.7-14.5個月，n = 182)；接 受引導化療，根治性化療及輔助化療的病人的中位生存期並未達到(n = 102)。30天內死亡率為3.5% (n = 10)。 所有死亡病人均為接受緩解化療的病人(佔所有緩解治療病人的5.5%)，其中一例病人死亡 與治療相關。
結論：本研究的結果比以往發表的相似年齡組的非臨床試驗結果要好。有關老年病人化療時的最理 想評估及處理須要進一步研究。