Clinical Translational Gastroenterology:80岁以上老年胃癌内镜黏膜下剥离术术后出血的危险因素分析

2021-10-25 MedSci原创 MedSci原创

胃癌(GC)是全世界主要的癌症类型之一,在日本、韩国和中国等东亚国家尤为普遍。

       胃癌(GC)是全世界主要的癌症类型之一,在日本、韩国和中国等东亚国家尤为普遍。事实上,与2012年每10万人的世界年龄标准化发病率为 12.1(男性 17.4 和女性 7.5)相比,韩国 2018 年的年龄标准化发病率为 39.6,其次是日本27.5 和中国20.7。治疗胃癌的手段有很多,其中内窥镜黏膜下剥离术 (ESD) 是治疗胃癌的有效手段之一。此外,一些与手术相关的因素也会影响手术时间和不良事件的发生率,包括刀具类型和凝血模式以及内窥镜医师的经验等等。在影响GC的ESD后出血的许多可能因素中,抗血栓药物被认为是主要的危险因素之一。

 

      随着社会老龄化进程的推进,日本80岁以上老年胃癌患者人数不断增加。虽然延迟性溃疡出血是内镜黏膜下剥离术 (ESD) 后的主要不良事件,但对接受 ESD 的老年患者出血的特征性危险因素知之甚少。本研究旨在评估80岁以上老年胃癌患者ESD术后延迟出血的危险因素。

 

 

      研究人员回顾性评估了2013年11月至2016年1月在日本33家机构接受ESD切除的 10,320 例早期胃癌患者的 ESD 后延迟出血发生率,并调查了 80 岁以上老年患者延迟出血的危险因素。

 

       研究结果显示:80岁以上老年患者迟发性出血发生率为5.7%(95%[CI]:4.6%~6.9%,95/1,675),显着高于非老年人(20岁及以下)患者(4.5%、95%[CI]:4.1%–5.0%、393/8,645)。在对治疗时预测因素的多变量分析中,老年患者的危险因素是血液透析(OR:4.591,95% CI:2.056–10.248,P<0.001)和华法林使用(OR:4.783,95% CI: 1.689–13.540,P=0.003)。

 

     我们都知道ESD 比开放手术侵入性更小,可提高早期 GC 患者的生活质量。但在老年人中由于患者的基础疾病增多,是否依然有效仍然不清楚,毕竟在过去的 20 年里,日本 85 岁以上的老年人口从 1.4 增加到 480 万,也从总人口的 1.2%增加到 3.8%。在这项多中心研究发现,日本 80 岁以上患者 ESD 后延迟出血的发生率较高,尤其是接受血液透析和服用华法林的患者。因此,对于老年患者的ESD使用要更加谨慎。

 

 

原始出处:

Sugimoto, Mitsushige. Et al. Risk Factors for Bleeding After Endoscopic Submucosal Dissection for Gastric Cancer in Elderly Patients Older Than 80 Years in Japan. Clinical and Translational Gastroenterology.2021.

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[GetPortalCommentsPageByObjectIdResponse(id=1712952, encodeId=f6741e1295202, content=<a href='/topic/show?id=9a1c289680' target=_blank style='color:#2F92EE;'>#AST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2896, encryptionId=9a1c289680, topicName=AST)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8b9831894722, createdName=ms24272190615788285182, createdTime=Thu Feb 03 01:00:09 CST 2022, time=2022-02-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1795946, encodeId=95c91e95946a0, content=<a href='/topic/show?id=42211e757d7' target=_blank style='color:#2F92EE;'>#Translation#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17757, encryptionId=42211e757d7, topicName=Translation)], attachment=null, authenticateStatus=null, 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style='color:#2F92EE;'>#GAS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7846, encryptionId=9d4ee84647, topicName=GAS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2dd327, createdName=许安, createdTime=Sat Jan 08 17:00:09 CST 2022, time=2022-01-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2067595, encodeId=4839206e5955e, content=<a href='/topic/show?id=d0841e75535' target=_blank style='color:#2F92EE;'>#Transl#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17755, encryptionId=d0841e75535, topicName=Transl)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/101173734/363C99735735B7F4CB11D5F78F580525/100, createdBy=aab22500211, createdName=ms3025846204744509, createdTime=Thu Oct 28 19:00:09 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createdBy=88b489038, createdName=yangchou, createdTime=Thu Oct 28 12:39:39 CST 2021, time=2021-10-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1262260, encodeId=79e212622608b, content=<a href='/topic/show?id=0ceb30545e0' target=_blank style='color:#2F92EE;'>#内镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30545, encryptionId=0ceb30545e0, topicName=内镜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Wed Oct 27 13:00:09 CST 2021, time=2021-10-27, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1712952, encodeId=f6741e1295202, content=<a href='/topic/show?id=9a1c289680' target=_blank style='color:#2F92EE;'>#AST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=60, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2896, encryptionId=9a1c289680, topicName=AST)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=8b9831894722, createdName=ms24272190615788285182, createdTime=Thu Feb 03 01:00:09 CST 2022, time=2022-02-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1795946, encodeId=95c91e95946a0, content=<a href='/topic/show?id=42211e757d7' target=_blank style='color:#2F92EE;'>#Translation#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17757, encryptionId=42211e757d7, topicName=Translation)], attachment=null, authenticateStatus=null, 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style='color:#2F92EE;'>#GAS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7846, encryptionId=9d4ee84647, topicName=GAS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2dd327, createdName=许安, createdTime=Sat Jan 08 17:00:09 CST 2022, time=2022-01-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2067595, encodeId=4839206e5955e, content=<a href='/topic/show?id=d0841e75535' target=_blank style='color:#2F92EE;'>#Transl#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17755, encryptionId=d0841e75535, topicName=Transl)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/101173734/363C99735735B7F4CB11D5F78F580525/100, createdBy=aab22500211, createdName=ms3025846204744509, createdTime=Thu Oct 28 19:00:09 CST 2021, time=2021-10-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1066438, encodeId=2a901066438b2, content=好文章,谢谢分享学习 , beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2020/02/15/7274ed1be4747d648e4e2f7f62fae403.jpg, createdBy=d8d65273314, createdName=1482963am12暂无昵称, createdTime=Wed Nov 03 00:22:58 CST 2021, time=2021-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1064651, encodeId=06101064651a9, content=好文章,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Thu Oct 28 12:39:39 CST 2021, time=2021-10-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1262260, encodeId=79e212622608b, content=<a href='/topic/show?id=0ceb30545e0' target=_blank style='color:#2F92EE;'>#内镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30545, encryptionId=0ceb30545e0, topicName=内镜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Wed Oct 27 13:00:09 CST 2021, time=2021-10-27, status=1, ipAttribution=)]
    2022-03-26 bsmagic9140
  6. 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style='color:#2F92EE;'>#GAS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=34, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7846, encryptionId=9d4ee84647, topicName=GAS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e2dd327, createdName=许安, createdTime=Sat Jan 08 17:00:09 CST 2022, time=2022-01-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2067595, encodeId=4839206e5955e, content=<a href='/topic/show?id=d0841e75535' target=_blank style='color:#2F92EE;'>#Transl#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=17755, encryptionId=d0841e75535, topicName=Transl)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/101173734/363C99735735B7F4CB11D5F78F580525/100, createdBy=aab22500211, createdName=ms3025846204744509, createdTime=Thu Oct 28 19:00:09 CST 2021, time=2021-10-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1066438, encodeId=2a901066438b2, content=好文章,谢谢分享学习 , beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cdnapi.center.medsci.cn/medsci/head/2020/02/15/7274ed1be4747d648e4e2f7f62fae403.jpg, createdBy=d8d65273314, createdName=1482963am12暂无昵称, createdTime=Wed Nov 03 00:22:58 CST 2021, time=2021-11-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1064651, encodeId=06101064651a9, content=好文章,谢谢分享。, beContent=null, objectType=article, channel=null, level=null, likeNumber=64, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJlfgys76DEiaNtbYo2re3ibjrUPTRibEXRyFwAB4aAGiave842S0FQDf0wAoaH226NiaSoPPDzhndsf1g/132, createdBy=88b489038, createdName=yangchou, createdTime=Thu Oct 28 12:39:39 CST 2021, time=2021-10-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1262260, encodeId=79e212622608b, content=<a href='/topic/show?id=0ceb30545e0' target=_blank style='color:#2F92EE;'>#内镜#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30545, encryptionId=0ceb30545e0, topicName=内镜)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Wed Oct 27 13:00:09 CST 2021, time=2021-10-27, status=1, ipAttribution=)]
    2022-01-08 许安
  7. 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  8. 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    2021-11-03 1482963am12暂无昵称

    好文章,谢谢分享学习

    0

  9. 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    2021-10-28 yangchou

    好文章,谢谢分享。

    0

  10. 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癌症导致的恶病质是癌症患者的一种高代谢状态,以肌肉萎缩和脂肪组织丢失为特征,一般的营养支持无法完全逆转。癌症恶病质降低了癌症患者治疗效果和总生存期。

中国已成癌症大国!肺癌死亡率飙升4倍,男性高于女性​

此次2020年的《全球癌症统计报告》 共涵盖全球185个国家、36种癌症。其主要内容包括6大部分:全球癌症分布、主要致癌因素、癌症的病理过程、社会因素对于癌症预防的影响、常见癌症的预防策略及其理论基础

Gastric Cancer:绝经后妇女胆固醇水平与胃癌风险呈负相关

众所周知,高胆固醇血症是导致心血管疾病的高风险因素,另一方面,胆固醇水平与癌症风险之间也存在相关关系。关于胃癌,多项研究表明胆固醇水平与胃癌呈负相关关系。

Lancet子刊:雷莫芦单抗联合紫杉醇可作为中国晚期胃癌或GEJ腺癌患者的二线治疗!

雷莫芦单抗联合紫杉醇可作为中国晚期胃癌或GEJ腺癌患者的二线治疗方案