老年人的肺癌

Lung Cancer in the Elderly

陳育民(Yuh-Min Chen)

《胸腔醫學》 17卷3期 (2002/09) Pp. 187-193

摘要

最近二十年來肺癌一直位居台灣癌症死因的前二名，肺癌是屬於一種較好發於晚年的癌症。發生率隨著年齡增加而逐漸增高，到80歲附近到達頂點。由於它是屬於一種老年人的癌症，對於老年肺癌的研究也就相對地顯得重要。老人肺癌的組織型態與年輕患者稍有差異，鱗狀細胞癌相對比年輕患者多，肺癌的分期也是較早期發現，但是卻較易接受不完整的治療，或是拒絕治療。
雖然我們認為老年人的各種器官功能均較年輕者為差，但是只要小心處理，臨床治療經驗卻發現二者差異不大。一般而言，肺癌的治療原則，不因年紀不同而有明顯差異。經診斷患有早期非小細胞肺癌的老年患者只要符合手術條件，並且沒有手術禁忌症，均可以施行手術切除，但是宜避免全肺切除手術。至於擴展期或晚期患者均可接受放射治療或化學藥物治療，而且患者耐受性並不比年輕人差。 某些文獻報告甚至認為老年人對藥物反應率較年輕人為佳。小細胞肺癌治療原則也不變。台北榮民總醫院自1987年至1996年共有6048位非小細胞肺癌病患。其中184人年紀超過80歲，另外127人年紀小於40歲，在小於40歲的病患以女性與肺腺癌較多，老年肺癌診斷時的期別相對較年輕人為早。但是，這些小於40歲的病患接受較積極治療的方式（如手術切除）比老年人為高。而且，老年病患只接受保守的支持性治療的比率明顯比年輕人為多。其中尚有許多可以改善的空間。台北榮民總醫院胸腔部的肺癌化學治療臨床試驗的經驗也顯示，老年患者接受化學藥物治療的耐受性不比年輕人差，且副作用也沒有明顯增加。
結論：肺癌是一種老人的疾病，只要能夠適當診斷、適當治療，其治療過程與預後和年輕患者並無明顯差異。

關鍵字

肺癌 ； 老年人 ； 化學藥物治療 ； 肺葉切除

並列摘要

Lung cancer has been the leading cause of cancer death in Taiwan in the past two decades. It is found in older individuals, as well, with a peak incidence at around 80 years of age. There is more squamous cell carcinoma, at a relatively early staging, among this group, and a higher proportion of elderly patients refuse treatment or receive incomplete treatment, when compared with younger patients. In general, the treatment policy for lung cancer is essentially the same, regardless of age. Surgical intervention, such as lobectomy with mediastinal LN dissection, is the treatment of choice for early-stage non-small cell lung cancer (NSCLC), while pneumonectomy should be avoided if possible. Radiotherapy and/or chemotherapy can also be given to locally advanced and/or metastatic NSCLC patients. The treatment policy for SCLC is also the same, regardless of age. There were 6,048 NSCLC patients diagnosed in Taipei VGH between 1987 and 1996. Among them, 127 patients were younger than 40 years old and 184 patients were older than 80 years old. We found significantly more female patients and adenocarcinoma in the younger group, when compared with the older patients. Younger patients received surgical intervention more frequently than the aged, but older patients received supportive care only more frequently than the younger patients. The chemotherapy clinical trials among NSCLC patients in our hospital have also showed that elderly patients tolerate treatment well. In summary, lung cancer is a common disease among the elderly, and the treatment policy and prognosis are essentially the same as for younger patients.

並列關鍵字

lung cancer ； elderly ； chemotherapy ； lobectomy