Page 84 - 2023-08-中国全科医学

2023年3月 第26卷 第8期 http: //www.chinagp.net E-mail: zgqkyx@chinagp.net.cn ·981·

*
Corresponding author：XU Qin，Professor，Doctoral supervisor；E-mail：qinxu@njmu.edu.cn
【Abstract】 Background Due to great differences in physiological reserve，psychological status and social
functioning，frailty in elderly patients with gastric cancer may present various subtypes. The relationship between preoperative
frailty and postoperative adverse outcomes in them still remains to be further explored. Objective To explore the relationship
between preoperative frailty subtypes and postoperative adverse outcomes〔total complications，prolonged length of stay
（PLOS），low quality of life（QOL），and disability〕among elderly patients with gastric cancer. Methods From March
to October 2021，404 elderly gastric cancer patients were selected from Department of Gastric Surgery，the First Affiliated
Hospital with Nanjing Medical University by convenience sampling. The General Demographic Data Questionnaire and Tilburg
Frailty Indicator were used to collect demographics and frailty status before surgery. Total complications and PLOS were collected
from the electronic medical records，and the status of disability and QOL were obtained using a telephone follow-up at one
month after discharge. Univariate Logistic regression was performed to explore the influencing factors of postoperative adverse
outcomes. Multivariate Logistic regression analysis was performed to analyze the association of preoperative frailty subtypes
with postoperative adverse outcomes，with potential confounders adjusted. Results Two hundred and eighty-five cases were
found with preoperative frailty，and the frailty subtypes in them were classified into eight classes：exclusive physical frailty
〔77（19.1%）〕，exclusive psychological frailty〔78（19.3%）〕，exclusive social frailty〔23（5.7%）〕，physical and
psychological frailty〔63（15.6%）〕，physical and social frailty〔13（3.2%）〕，psychological and social frailty〔16（4.0%）〕，
multidimensional frailty（physical，psychological，and social frailty）〔15（3.7%）〕. The other 119（29.5%） cases had no
preoperative frailty. In the univariate Logistic regression，age was the factor influencing total complications〔OR=1.063，95%CI
（1.021，1.106），P=0.003〕. History of pharmacological treatment〔OR=1.549，95%CI（1.016，2.362），P=0.042〕and
surgical approach〔OR=2.103，95%CI（1.191，3.712），P=0.010〕were the factors influencing PLOS. Marital status〔OR=4.611，
95%CI（1.079，19.706），P=0.039〕，living in an urban area〔OR=1.614，95%CI（1.009，2.582），P=0.046〕，having
at least two comorbidities〔OR=1.694，95%CI（1.038，2.766），P=0.035〕were the factors influencing postoperative low
QOL. Living in an urban area〔OR=0.601，95%CI（0.390，0.926），P=0.021〕，history of pharmacological treatment〔OR=1.663，
95%CI（1.082，2.558），P=0.020〕，and advanced TNM stages〔OR=1.659，95%CI（1.017，2.706），P=0.043〕were
the factors influencing postoperative disability. In the multivariate Logistic regression，the preoperative multidimensional frailty
was independently associated with total complications，with age adjusted〔OR=5.344，95%CI（1.715，16.656），P=0.004〕.
The preoperative physical frailty〔OR=2.048，95%CI（1.078，3.891），P=0.029〕，preoperative psychological frailty〔OR=2.077，
95%CI（1.103，3.913），P=0.024〕and preoperative multidimensional frailty〔OR=8.321，95%CI（2.400，28.848），
P<0.001〕were independently associated with PLOS，with history of pharmacological treatment and surgical approach adjusted.
Preoperative psychological frailty〔OR=2.620，95%CI（1.267，5.418），P=0.009〕，preoperative psychological and social
frailty〔OR=11.122，95%CI（3.253，38.028），P<0.001〕and preoperative multidimensional frailty〔OR=11.579，95%CI（2.835，
47.302），P<0.001〕were independently associated with postoperative low QOL，with marital status，living in an urban area，
and having at least two comorbidities adjusted. Conclusion Medical professionals should pay attention to preoperative frailty
prevalence in elderly gastric cancer patients，and assess preoperative frailty in these patients using tools with the multidimensional
frailty scale included，and attach great importance to those with exclusive physical frailty，exclusive psychological frailty，
psychological and social frailty，and multidimensional frailty before surgery. A targeted prerehabilitation intervention program can
be delivered to those with preoperative frailty according to their subtypes of frailty to improve postoperative adverse outcomes and
QOL.
【Key words】 Stomach neoplasms；Castric cancer；Frailty；Aged；Tilburg Frailty Indicator；Quality of life；
Adverse outcomes；Precision medicine

根据国际癌症研究机构的最新数据显示，全球约有 会等储备降低的多维度衰弱状态 ［2-3］ ，易出现并发症、
108.9 万例胃癌新发病例和 76.9 万例死亡病例，发病率 住院时间延长、失能及死亡等不良结局 ［4-6］ 。因此，术
居恶性肿瘤第 5 位，死亡率居第 4 位 ［1］ 。手术是胃癌 前衰弱管理至关重要，其首要环节为衰弱评估。目前，
的主要治疗方式，随着人口老龄化进程不断加快，接受 术前的衰弱评估仅以二分类（衰弱或非衰弱）的形式识
胃癌手术的老年患者逐渐增加。由于机体老化、肿瘤自 别整体衰弱水平。这一方法虽可识别高危群体，但易忽
身及其带来的一系列营养、骨骼肌代谢异常，老年胃癌 略个体差异，掩盖具体的衰弱维度，导致术前风险分层
患者术前常处于机体多系统功能受损和生理、心理、社 及干预措施制订缺乏精准性，进一步导致医疗资源过度