Pankreatikoduodenektomi Geçiren Orta Yaşlı (75-84 Yaş) Hastalarda Fizyolojik Rezervin Genel Sağkalım Üzerindeki Etkisi: Tek Merkezli Retrospektif Analiz

Öz

Artan yaşam beklentisiyle birlikte, pankreas kanseri nedeniyle pankreatikoduodenektomi (PD) uygulanan yaşlı hastaların sayısı artmaktadır. Ancak, bu yaş grubunda genel sağkalımı (GS) etkileyen fizyolojik belirteçler net bir şekilde tanımlanmamıştır. Bu çalışma, PD geçiren 75-84 yaş arası orta yaşlı hastalarda GS etkileyen faktörleri değerlendirmeyi amaçlamaktadır. Bu retrospektif çalışmada, PD geçiren orta yaşlı hastalar incelenmiş ve GS durumlarına göre iki gruba ayrılmıştır. Performans durumu, beslenme durumu ve kırılganlık düzeyi klinik ve laboratuvar tabanlı ölçeklerle değerlendirilmiştir. Toplam 34 hasta çalışmaya dahil edilmiştir (ortanca yaş 77,5 yıl [76-79,2]; %58,8 erkek). ECOG 2, sağ kalamayan grupta anlamlı derecede daha yüksekti (%62,5'e karşı %22,2; p=0,017). GNRI ≥98 sağ kalım grubunda daha sık gözlendi (%72,2'ye karşı %31,3; p=0,017). FI-Lab ≥0,25 sağ kalamayan grupta daha yüksekti (%56,3'e karşı %11,1; p=0,005). Adjuvan kemoterapi tedavisi sağ kalım grubunda daha yüksekti (%88,9'a karşı %43,8; p=0,005). Kaplan-Meier analizinde, GNRI ≥98, ECOG 1 ve FI-Lab <0,25 olan hastalarda medyan sağ kalım anlamlı derecede daha uzundu (hepsi için p<0,01). Tek değişkenli analizde, ECOG 2 (HR=0,11; p=0,001), GNRI <98 (HR=0,21; p=0,011) ve FI-Lab ≥0,25 (HR=0,14; p=0,002) daha yüksek mortalite riski ile ilişkiliydi. Ancak, çok değişkenli analizde bu parametrelerden hiçbiri GS için bağımsız ve istatistiksel olarak anlamlı bir prognostik risk faktörü olarak tanımlanmamıştır. Bu çalışma, PD geçiren orta yaşlı hastalarda performans durumu, beslenme durumu ve kırılganlık düzeyinin genel sağkalım ile bağımsız bir ilişki göstermediğini ortaya koymuştur.

Anahtar Kelimeler

• Pankreatikoduodenektomi
• Orta yaşlı
• Genel sağkalım
• ECOG performans skoru
• Kırılganlık
• Geriatrik beslenme risk indeksi

Impact of Physiological Reserve on Overall Survival in Middle-Old (75–84 Years) Patients Undergoing Pancreaticoduodenectomy: A Single-Center Retrospective Analysis

Öz

With increasing life expectancy, the number of elderly patients undergoing pancreaticoduodenectomy (PD) due to pancreatic cancer is increasing. However, physiological markers affecting overall survival (OS) in this age group have not been clearly defined. This study aims to evaluate the factors affecting OS in middle-old patients aged 75–84 years who underwent PD. In this retrospective study, middle-old patients who underwent PD were examined and divided into two groups according to OS status. Performance status, nutritional status, and frailty level were assessed with clinical and laboratory-based scales. A total of 34 patients were included (median age, 77.5 years [76–79.2]; 58.8% male). ECOG 2 was significantly higher in the non-survivor group (62.5% vs. 22.2%; p=0.017). GNRI ≥98 was observed more frequently in the survival group (72.2% vs. 31.3%; p=0.017). FI-Lab ≥0.25 was higher in the non-survival group (56.3% vs. 11.1%; p=0.005). Adjuvant chemotherapy treatment was higher in the survival group (88.9% vs. 43.8%; p=0.005). In Kaplan–Meier analysis, median survival was significantly longer in patients with GNRI ≥98, ECOG 1, and FI-Lab <0.25 (p<0.01 for all). In univariate analysis, ECOG 2 (HR=0.11; p=0.001), GNRI <98 (HR=0.21; p=0.011), and FI-Lab ≥0.25 (HR=0.14; p=0.002) were associated with a higher risk of mortality However, in multivariate analysis, none of these parameters were identified as independent and statistically significant prognostic risk factors for OS. This study demonstrates that performance status, nutritional status, and frailty level are not independently associated with OS in middle-old patients undergoing PD.

Anahtar Kelimeler

• Pancreaticoduodenectomy
• Middle-old
• Overall survival
• ECOG performance score
• Frailty
• Geriatric nutritional risk index

Kaynakça

1. 1. Office for National Statistics. Estimates of centenarians in the UK. Available at: http://www.ons.gov.uk/ons/rel/mortality-ageing/population-estimates-of-the-very-elderly/2010/sum-eve-2010.html. Accessed September 17, 2025.
2. 2. United States Census Bureau. Sixty‐five plus in the United States. 2001. Available at: http://www.census.gov/population. Accessed September 10, 2025.
3. 3. Siegel RL, Kratzer TB, Giaquinto AN, Sung H, Jemal A. Cancer statistics, 2025. CA Cancer J Clin. 2025;75(1):10-45.
4. 4. Neoptolemos JP, Kleeff J, Michl P, Costello E, Greenhalf W, Palmer DH. Therapeutic developments in pancreatic cancer: current and future perspectives. Nat Rev Gastroenterol Hepatol. 2018;15(6):333-348.
5. 5. Renz BW, Khalil PN, Mikhailov M, Graf S, Schiergens TS, Niess H, Boeck S, et al. Pancreaticoduodenectomy for adenocarcinoma of the pancreatic head is justified in elderly patients: A Retrospective Cohort Study. Int J Surg. 2016;28:118-125.
6. 6. Uijterwijk BA, Wei K, Kasai M, Ielpo B, Hilst JV, Chinnusamy P, et al. Minimally invasive versus open pancreatoduodenectomy for pancreatic ductal adenocarcinoma: Individual patient data meta-analysis of randomized trials. Eur J Surg Oncol. 2023;49(8):1351-1361.
7. 7. Gungor F, Babayev A, Onak C, Acar T, Bag H, Kar H, et al. Mortality after pancreaticoduodenectomy: Single center outcomes. HPB (Oxford). 2020;22(Suppl 2):S302.
8. 8. Beltrame V, Gruppo M, Pastorelli D, Pedrazzoli S, Merigliano S, Sperti C. Outcome of pancreaticoduodenectomy in octogenarians: Single institution's experience and review of the literature. J Visc Surg. 2015;152(5):279-284.

9. 9. Henry AC, Schouten TJ, Daamen LA, Walma MS, Noordzij P, Cirkel GA, et al. Short- and Long-Term Outcomes of Pancreatic Cancer Resection in Elderly Patients: A Nationwide Analysis. Ann Surg Oncol. 2022;29(9):6031-6042.
10. 10. Pineño-Flores C, Ambrona-Zafra D, Rodríguez-Pino JC, Soldevila-Verdeguer C, Palma-Zamora E, Molina-Romero FX, et al. Cephalic pancreaticoduodenectomy for ductal adenocarcinoma in the elderly. Can we do it safely?. Cir Esp (Engl Ed). 2022;100(3):125-132.
11. 11. Oliveira-Cunha M, Malde DJ, Aldouri A, Morris-Stiff G, Menon KV, Smith AM. Results of pancreatic surgery in the elderly: is age a barrier?. HPB (Oxford). 2013;15(1):24-30.
12. 12. Lee SB, Oh JH, Park JH, Choi SP, Wee JH. Differences in youngest-old, middle-old, and oldest-old patients who visit the emergency department. Clin Exp Emerg Med. 2018;5(4):249-255.
13. 13. Bouillanne O, Morineau G, Dupont C, Coulombel I, Vincent JP, Nicolis I, et al. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr. 2005;82(4):777-783.
14. 14. Blodgett JM, Theou O, Howlett SE, Rockwood K. A frailty index from common clinical and laboratory tests predicts increased risk of death across the life course. Geroscience. 2017;39(4):447-455.
15. 15. Xue K, Liu X, Wang L, Xiong J, Tian B. Perioperative outcomes in elderly patients undergoing pancreatoduodenectomy: a propensity-matched analysis. ANZ J Surg. 2025;95(6):1162-1170.
16. 16. Zhang Y, Han S, Xu Y, Liu L, Wu W, Zhang L, et al. Pancreatic surgery is safe in elderly patients with PDAC. BMC Geriatr. 2025;25(1):438.
17. 17. Mocchegiani F, Benedetti Cacciaguerra A, Wakabayashi T, Valeriani F, Vincenzi P, Gaudenzi F, et al. Textbook outcome following pancreaticoduodenectomy in elderly patients: age-stratified analysis and predictive factors. Updates Surg. 2025;77(5):1501-1511.
18. 18. Liu X, Xue K, Zhang Y, Tian B. Geriatric nutritional risk index predicts postoperative outcomes in elderly patients with pancreatoduodenectomy: a propensity score-matched analysis. Gland Surg. 2025;14(5):807-817.
19. 19. Funamizu N, Omura K, Takada Y, Ozaki T, Mishima K, Igarashi K, et al. Geriatric Nutritional Risk Index Less Than 92 Is a Predictor for Late Postpancreatectomy Hemorrhage Following Pancreatoduodenectomy: A Retrospective Cohort Study. Cancers (Basel). 2020;12(10):2779.
20. 20. Funamizu N, Omura K, Ozaki T, Honda M, Mishima K, Igarashi K, et al. Geriatric nutritional risk index serves as risk factor of surgical site infection after pancreatoduodenectomy: a validation cohort Ageo study. Gland Surg. 2020;9(6):1982-1988.
21. 21. Kim Y, Song K, Kang CM, Lee H. Impact of preoperative laboratory frailty index on mortality and clinical outcomes in older surgical patients with cancer. Sci Rep. 2022;12(1):9200.
22. 22. Funamizu N, Mori S, Sakamoto A, Honjo M, Tamura K, Sakamoto K, et al. Novel modified frailty index predicts completion of adjuvant chemotherapy in resectable pancreatic cancer in a dual center study. Sci Rep. 2025;15(1):17000.
23. 23. Ergenç M, Uprak TK, Özocak AB, Karpuz Ş, Coşkun M, Yeğen C, et al. Pancreaticoduodenectomy in patients < 75 years versus ≥ 75 years old: a comparative study. Aging Clin Exp Res. 2024;36(1):141.
24. 24. Attard JA, Al-Sarireh B, Bhogal RH, Farrugia A, Fusai G, Harper S, et al. Short-term outcomes after pancreatoduodenectomy in octogenarians: multicentre case-control study. Br J Surg. 2021;109(1):89-95.
25. 25. He J, Li J, Liu J, Liu M. Sarcopenia as a prognostic marker in patients undergoing pancreaticoduodenectomy: an updated meta-analysis. Front Oncol. 2025;15:1656834.