老年肿瘤患者综合评估的现状

肿瘤与年龄密切相关,近60％的肿瘤发生于65岁及以上人群,80％的肿瘤死亡发生于这一年龄组。65岁及以上人群肿瘤的发病率比65岁以下人群高近10倍,其肿瘤死亡率是65岁以下人群的16倍。这与老年肿瘤患者的生理特点及治疗的复杂性有关,因此如何更好地治疗老年肿瘤患者已经成为肿瘤学领域和老年病学领域共同关心的内容。     

社区老年人综合评估研究进展及应用综述

老年综合评估是一种多维度、跨学科的评估方法,能够早期发现老年人潜在的问题和功能缺陷,减少跌倒、失能、住院、死亡等不良结局的发生,降低社会的医疗和照护负担。现有国外的评估工具包括欧洲老年人评估系统、国际居民评估工具、多维预后指数、患者报告结局测量信息系统,这些是更为标准化、体系化的老年综合评估工具。国内是由各研究机构基于一定理论框架,精选各个维度单项量表的评估内容,并对整个量表的信效度进行验证和评价,多为单一场景应用的老年综合评估工具。目前国内外老年综合评估研究对象更关注急诊、住院患者,对于社区老年群体关注较少。另外,国内实施社区老年综合评估的循证医学证据不足,缺失前瞻性和干预性研究。本文对国内外社区综合评估研究工具研制和应用情况进行综述,探讨目前社区老年综合评估研究遇到的问题和可能的解决方案,以期将预防和控制老年人健康危险因素的关口前移、延缓不良事件的发生发展、降低照护负担、提高老年人生活质量。     

老年综合评估在老年血液系统肿瘤患者中的研究进展

随着老年人血液系统肿瘤发病率的逐年升高,如何更好地评估老年血液肿瘤患者对化疗的耐受性是困扰临床医师的问题.最近老年综合评估开始用于老年血液肿瘤患者,研究发现老年综合评估可以判断患者预后,预测患者对治疗的耐受性,并有可能指导治疗决策.文章对国内外老年综合评估在血液肿瘤的研究现状进行综述.     

老年综合评估在老年肿瘤患者中应用的研究进展

年龄超过65岁的老年人恶性肿瘤的发病率及死亡率近年来明显升高。老年人是一个异质性群体,自然年龄与其生理状态不一致。为了确保对老年肿瘤患者采取的治疗措施安全有效,肿瘤科医生应全面了解老年患者的生理及功能状态。老年综合评估是一项多学科多维度的有关老年患者健康和功能状态的评估系统。现已证明它对发现老年肿瘤患者潜在的健康问题、预测治疗相关不良反应、评估预后及治疗效果,帮助制定肿瘤治疗决策有重要意义。     

老年综合评估在老年癌症患者疼痛管理中的应用进展

疼痛是晚期癌症患者的主要痛苦和需要改善的重要症状,老年综合评估是老年医学实践的重要工具,可以对疼痛、衰弱等综合征进行有效的评估,并给以恰当管理,从而最大限度的减轻疼痛,提高老年肿瘤患者的生存质量,在老年医学的基础研究和临床实践中有着重要意义.本研究对老年综合评估在老年癌症患者疼痛管理中的应用进展研究进行相关综述.     

49例老年小细胞肺癌综合治疗的临床观察

目的探讨应用密集周化疗及多学科综合治疗方案治疗老年小细胞肺癌（small—celllungcancer,SCLC）的疗效、耐受性及生存预后因素。方法对1995年3月至2005年12月入组的49例老年（≥60岁）SCLC患者采取CODE（顺铂、长春新碱、多柔比星及依托泊苷）密集周化疗,总疗程9周。首次化疗方案完成后,根据患者的KPS评分和心肺功能确定是否接受胸部放射治疗（radiotherapy,RT）和（或）维持治疗（maintenancechemotherapy,MCT）以及最佳支持治疗（bestsupportivecare,BSC）。符合手术条件的病例于CODE前或后行胸部手术。按WHO实体瘤通用标准进行疗效评定,应用Kaplan—Meier法绘制生存曲线,寿命表法计算生存率,COX多因素回归比例风险模型分析生存预后因素。并与同期同方案治疗的SCLC轻年组（〈60岁）69例进行比较。结果老年组患者占同期人组病例41．5％（49／118例）,可进行CODE疗效评定的患者为45例。评价结果为CR13例（28．9％）,PR30例（66．7％）,PD2例（4．4％）。随后完成的综合治疗有CODE＋RT＋MCT（34例）、OP＋CODE＋RT＋MCT（5例）、CODE＋RT或CODE＋MCT（8例）、CODE＋BSC（2例）。综合疗效分别为CR38．8％、PR53．1％和PD8．2％。老年组中位生存时间（mediansurvivaltime,MST）23个月（95％CI：16～30）,其中局限期（LD）为37个月（95％CI：16～58）,广泛期（ED）为18个月（95％CI：12～24）,P=0．027。1年、5年生存率LD为92．3％和30．8％,ED为80．6％和11．1％（P值分别为0．308、0．116）。单因素分析显示KPS评分、疾病分期、治疗模式、CODE疗效和综合治疗疗效可影响老年患者生存（P〈0．05）。多因素分析显示疾病分期和综合治疗疗效是影响患者生存的独立预后因素（P〈0．05）。老年组与轻年组MST及1年、5年生存率无明显统计学差异（P〉0．05）。结论CODE密集周化疗及选择性个体化综合治疗,可提高老年SCLC患者的疗效,有更好的安全性,明显延长生存期。     

康莱特在肺癌综合治疗中的作用

 目的　康莱特注射液配合放化疗治疗肺癌,观察其疗效及对生存质量的影响。方法　1997年4月至1999年4月治疗了35例肺癌,每位患者给与康莱特注射液100ml iv qd×20天,联合应用CE、EP、ACO方案化疗及常规设野放疗,观察治疗前后患者生活质量、体重变化及疗效。结果　治疗有效率为60%。合用康莱特治疗后,癌症患者的生活质量提高,体重增加或稳定。结论　康莱特注射液对原发性肺癌有一定的治疗作用,与放化疗合用,可提高疗效,改善患者生活质量。     

综合老年评估指数作为老年B细胞淋巴瘤患者独立预后因素的研究进展

中国是一个人口大国,且人口老龄化进程加快。老年患者群体普遍存在着的躯体功能、心理以及社会等众多方面的医疗需求,因此急需对老年群体的健康状况进行全面的了解,从而为这类特殊人群制定个体化的诊疗方案。综合老年评估（comprehensive geriatric assessment,CGA）主要内容包括全面的医疗评估、躯体功能评估、认知和情感评估以及社会及环境因素评估等4个方面,是中国老年医学的核心技能。中外多项研究已经证实CGA评分可作为接受免疫化疗的老年B细胞淋巴瘤患者的独立预后因素,用于预测老年B细胞淋巴瘤患者的生存结局。建议在中国老年B细胞淋巴瘤患者接受免化疗前进行推广和实行CGA,以利于为中国60岁以上B细胞淋巴瘤患者制定精准治疗策略和个体化干预手段。     

肺癌，综合治疗效果好

肺癌有多种治疗方法，首选的治疗方法仍是外科手术切除。从治疗的效果来看，目前以手术切除疗效最佳。但是，当确诊为肺癌时，能接受外科手术治疗者仅占20％～30％，大多数病人在确诊时已丧失手术机会。当然，具有手术条件的肺癌病人不应放弃手术治疗机会。     

三维重建技术在老年肺癌合并肺结核患者胸腔镜肺癌根治术中的应用效果

目的 探讨三维重建技术在老年肺癌合并肺结核患者胸腔镜肺癌根治术中的应用效果。方法 回顾性分析84例行胸腔镜肺癌根治术的老年肺癌合并肺结核患者的病历资料,依据治疗措施的不同将其分为2组,依据多排螺旋CT增强图像施行手术治疗的38例患者为对照组,运用三维重建技术制定并施行手术的46例患者纳入观察组,所有患者均观察到术后3个月。对比2组手术相关指标、生活质量、并发症。结果 观察组手术时间[(102.36±10.58)min]、住院时间[(7.15±1.63)d]短于对照组[(113.59±12.75)min、(9.48±2.31)d],术中出血量[(78.63±8.29)ml]、术后引流量[(438.97±24.23)ml]少于对照组[(106.59±10.71)ml、(620.57±26.75)ml],术中淋巴结清扫个数[(11.69±1.92)个]多于对照组[(8.31±1.57)个],并发症发生率[6.52%(3/46)]低于对照组[23.68%(9/38)],有统计学差异(P<0.05)。术前,2组生活质量综合评定问卷(GQOLI-74)内各个维度的评分比较,无统计学差异(P&...     

Management and geriatric assessment of cancer in the elderly

Due to the demographic evolution, the management of elderly patients with cancer currently represents a major challenge for the medical community. Aging may be associated with an increased rate of health problems possibly resulting in a loss of independence. These problems can interfere with cancer treatment strategies. Therefore, treatment decision making requires a multidisciplinary and multidimensional assessment of both the characteristics of the malignant disease and the host’s general health status. Several oncological groups have developed specific programs for elderly cancer patients. Based on a multidimensional geriatric assessment tool, they aim to establish the best pattern of care for the population of elderly patients with cancer. Clinical research in geriatric oncology is also a very exciting field, particularly regarding the conception of clinical trials specifically designed for elderly patients. The particular aspects of the management of elderly patients with cancer and some critical challenges of clinical research will be presented and discussed in this review.     

晚期肺癌肝转移的综合治疗进展

肝脏是肺癌血液转移常见的部位。存在肝转移患者病情迅速发展，多在7个月内死亡。因此，采取积极有效的治疗措施，对进一步改善晚期肺癌患者的预后有极其重要的意义。目前，针对肺癌肝转移的治疗还没有达成统一的治疗计划，常见的治疗方法有手术治疗、全身化疗、介入治疗、射频消融治疗、立体定向放疗、靶向治疗、免疫治疗等。对此，我们就近年来肺癌肝转移的综合治疗进展作一综述。     

Serial comprehensive geriatric assessment in elderly head and neck cancer patients undergoing curative radiotherapy identifies evolution of multidimensional health problems and is indicative of quality of life

Head and neck (H&N) cancer is mainly a cancer of the elderly; however, the implementation of comprehensive geriatric assessment (CGA) to quantify functional age in these patients has not yet been studied. We evaluated the diagnostic performance of screening tools [Vulnerable Elders Survey‐13 (VES‐13), G8 and the Combined Screening Tool ‘VES‐13 + (17‐G8)’ or CST], the feasibility of serial CGA, and correlations with health‐related quality of life evolution [HRQOL; European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ)‐C30 and ‐HN35] during therapy in hundred patients, aged ≥65 years, with primary H&N cancer undergoing curative radio(chemo)therapy. Respectively 36.8%, 69.0%, 62.1% and 71.3% were defined vulnerable according to VES‐13, G8, CST and CGA at week 0, mostly due to presence of severe grade co‐morbidities, difficulties in community functioning and nutritional problems. At week 4, significantly more patients were identified vulnerable due to nutritional, functional and emotional deterioration. The CST did not achieve the predefined proportion necessary for validation. Vulnerable patients reported lower function and higher symptom HRQOL scores as compared with fit patients. A comparable deterioration in HRQOL was observed in both groups through therapy. In conclusion, G8 remains the screening tool of choice. Serial CGA identifies the evolution of multidimensional health problems and HRQOL conditions during therapy with potential to guide individualised supportive care.     

老年人晚期非小细胞肺癌系统性治疗的研究进展

老年患者是非小细胞肺癌（non-small cell lungcancer, NSCLC）的主要患病人群。由于年龄因素,老年患者多 器官储备下降,并发症的发生率较高,导致其耐受性较年轻患者低,治疗方案选择受到限制。因此,针对老年晚期NSCLC 患者身体状况的有效评估和治疗方案的选择成为目前的挑战和人们关注的焦点。老年晚期非小细胞肺癌患者的系统性治疗 如化疗、靶向治疗和免疫治疗,已被逐步研究并取得突破性进展。整体上,对于化疗,在老年人中进行的多项临床试验显 示,以铂类为基础的双药联合治疗取得令人满意的结果;对于抗血管生成剂,目前并没有足够的证据表明其可在老年晚期 NSCLC 患者中安全应用;TKI 药物在携带特定驱动突变的老年患者中表现出良好的应答和耐受性,但特定基因突变在老年 患者中发生频率明显低;免疫检查点抑制剂通过改善肿瘤患者免疫状态的策略在老年患者中也获得一定的疗效,因此年龄 不应该成为衡量是否接受免疫治疗的唯一因素。本文主要对老年人群系统性治疗的最新研究进展和相关指南推荐进行系列 综述,希望在指导老年患者治疗方案的选择上提供借鉴。     

Chemotherapy in elderly patients with advanced non-small cell lung cancer

Because of increasing life expectancy and of higher risk of cancer with ageing, lung cancer in elderly is a frequent disease. For a long time nihilism influenced treatment decisions in elderly patients with advanced non-small cell lung cancer. Since the beginning of the last decade single agent chemotherapy has been accepted as standard of care, vinorelbine and gemcitabine being the most frequently used drugs in Europe and US, docetaxel in Japan.Platinum-based doublets have been shown to be superior to monotherapy in young and fit patients with advanced non-small cell lung cancer. Although there were some indications from subgroup analyses of clinical trials not specifically dedicated to elderly patients that a platinum-based doublet might also benefit to older patients, there was no definitive proof of concept until ASCO meeting 2010. At this meeting results of a phase 3 trial showed that PS 0-2 patients, aged 70-89 years drove a significant benefit from a treatment with carboplatin associated to weekly paclitaxel compared to a monotherapy. Thus, the paradigm of treatment in elderly patients should perhaps be modified from a single agent to doublet chemotherapy. Whether other platinum-based doublets would provide the same benefit as the specific one studied remains to be evaluated.     

Health-related quality of life in elderly cancer patients, elderly non-cancer patients and an elderly general population

Health-related quality of life (QoL) is a major topic within the care for cancer patients (CP). Compared with the general population (GP), QoL of CP is worse in most dimensions; however, only few data comparing QoL of CP with that of other patients have been provided so far. We determined QoL with the European Organization for Research and Treatment of Cancer QLQ-C30 questionnaire in hospitalized patients aged 60 years and older: 195 CP and 130 patients treated for other medical disorders (MP). In addition, data were compared with an age- and gender-stratified German GP. Explorative statistical analyses were performed. The CP aged ≥70 years compared with those aged 60–69 years had decreased QoL in two scales, physical and cognitive functioning, MP in four scales, physical and role functioning, fatigue and dyspnoea respectively. Compared with the GP, both CP and MP had worse QoL in almost all scales. The CP and MP differed in two of 15 scales only, with CP having lower scores in emotional functioning and more loss of appetite. In conclusion, reduced QoL in elderly CP compared with GP cannot solely be attributed to the diagnosis of cancer, but also to a medical disorder requiring inpatient hospital care.     

Impact of comprehensive geriatric assessment on quality of life,overall survival,and unplanned admission in patients with non-small cell lung cancer treated with stereotactic body radiotherapy

Objectives

Overall survival ?OS? for patients with localized non-small cell lung cancer ?NSCLC? treated with stereotactic body radiotherapy ?SBRT? is poorer than for patients undergoing surgery. Patients who undergo SBRT are often ineligible for surgery due to significant comorbidities that can impact their mortality. A comprehensive geriatric assessment (CGA) that identifies and treats aging related comorbidities could improve OS and quality of life (QoL). This randomized study investigated if a CGA added to SBRT impacts QoL, survival, and unplanned admissions.

老年肺癌患者预后因素分析

背景与目的全球肺癌的发病率及死亡率最高,老年肺癌的发病人数亦在增加。虽然国际上有几项大样本研究了老年NSCLC的预后因素,结果不尽一致。本文旨在分析我国老年肺癌患者(≥65岁)的预后因素。方法收集2000年1月～2004年12月在湖北省肿瘤医院就诊的肺癌患者278例,其中≥65岁的老年肺癌患者140例(研究组),≤64岁的肺癌患者138例(对照组),分析临床资料、预后因素,并比较生存时间的差异。结果对于Ⅱ～ⅢA期患者,研究组的中位生存期为27月(95%CI:24.0～30.1),明显低于对照人群的35个月(95%CI:32.0～38.0),P=0.039。但对于ⅢB～Ⅳ期患者,不论采用序贯放化疗、单纯放疗、化疗或姑息治疗,老年组的预后(11个月,95%CI:9.2～12.8)与非老年组的预后(12个月95%CI:11.1～13.9)无明显差异,P=0.92。在研究组和对照组,最常见的毒副作用均为恶心呕吐,但组间无明显差异;其次为骨髓抑制中的白细胞减少,研究组明显高于对照组(x~2=4.3,P=0.04)。老年组食欲下降和疲乏的发生率要高,但无统计学差异。结论两组生存时间相似,研究组中位生存期14.0个月(95%CI:11.6～16.4),对照组中位生存期16个月(95% CI:13.1～18.9),无显著性差异(Log Rank=3.4,P=0.067)。两组有显著意义的预后因素均为性别、临床分期和采用以手术为主的治疗。对于Ⅱ～ⅢA期老年肺癌患者,由于未能接受以手术为主的综合治疗,预后要比年轻患者差,但对于ⅢB～Ⅳ期患者,不论采用序贯放化疗、单纯放疗、化疗或姑息治疗,老年组的预后(11个月,95%CI:9.2～12.8)与非老年组的预后(12个月,95%CI:11.1～13.9)无明显差异,Log Rank= 0.01,P=0.92,提示年龄不是影响预后的主要因素。但老年肺癌患者的耐受性差,不能接受强化治疗。     

早期姑息治疗在肺癌治疗中的积极作用

肿瘤姑息治疗医学是一门独立临床学科,世界卫生组织已将其列入全球癌症预防和控制策略的发展纲要。目前作为肺癌多学科治疗的重要组成部分,姑息治疗已被认为应当贯穿诊治的全程。相关随机对照试验表明,早期姑息治疗不仅可以使患者的生存期获得延长,其和照顾者的生活质量得到改善,抑郁症状减少,同时也让医疗资源得以合理分配,在肺癌的治疗中有非常重要的价值。本文对姑息治疗的概念、理念的转变、肺癌姑息治疗的方式、与抗癌治疗的关系及不同阶段肺癌患者接受早期姑息治疗的意义等方面进行综述,旨在为肺癌的综合治疗提供参考。