老年胃癌幸存者虚弱症异质性轨迹研究及预后分析

周瑜玲; 陈吉祥; 经雨; 吴海勤; 周敏; 施文燕; 范昕

doi:10.16766/j.cnki.issn.1674-4152.004364

老年胃癌幸存者虚弱症异质性轨迹研究及预后分析

doi: 10.16766/j.cnki.issn.1674-4152.004364

1.
江苏大学附属医院胃肠外科，江苏镇江 212000
2.
江苏大学附属医院泌尿外科

基金项目:

江苏省卫生健康委员会老年健康重点项目 LKZ2023012

江苏省青年医学重点人才项目 QNRC2016839

镇江市科技计划项目 SS2023011

详细信息

通讯作者:
范昕，E-mail：drfanxin@163.com

中图分类号: R735.2
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出版历程
- 收稿日期: 2025-02-07
- 网络出版日期: 2026-04-11

Heterogeneous frailty trajectory and prognostic analysis in elderly gastric cancer survivors

1.
Department of Gastrointestinal Surgery, Affiliated Hospital of Jiangsu University, Zhenjiang, Jiangsu 212000, China

摘要

摘要: 目的探讨老年胃癌幸存者虚弱症异质性变化轨迹及影响因素，并进行预后分析。方法选取2020年6月—2022年6月江苏大学附属医院收治的488例老年胃癌患者，采用Tilburg虚弱指数(TFI)评估患者入院时和术后1、3、6、9、12个月时的虚弱程度。采用增长混合模型(GMM)识别虚弱轨迹亚型，并采用多因素logistic回归分析研究不同轨迹亚型的影响因素，采用Kaplan-Meier生存曲线分析不同轨迹亚型与患者总体生存率的关系。结果 GMM模型识别出3种虚弱轨迹亚型，分别为低程度虚弱下降型[252例(51.6%)]、中程度虚弱平稳型[124例(25.4%)]和中程度虚弱增长型[112例(23.0%)]。多因素logistic回归分析显示，年龄、糖尿病、贫血、婚姻状况、个人月收入和微型营养评估量表(MNA-SF)评分均为中程度虚弱平稳型的独立影响因素(P＜0.05)；年龄、糖尿病、家庭照顾者、个人月收入、MNS-SF评分和社会支持评定量表(SSRS)评分均为中程度虚弱增长型的独立影响因素(P＜0.05)。低程度虚弱下降型总体生存率高于中程度虚弱平稳型和中程度虚弱增长型(P＜0.05)；中程度虚弱平稳型总体生存率高于中程度虚弱增长型(P＜0.05)。结论老年胃癌幸存者术后表现出3种虚弱轨迹亚型，不同虚弱轨迹亚型有不同的独立影响因素且和预后相关。
- 胃癌 /
- 虚弱 /
- 老年 /
- 轨迹 /
- 预测因素
Abstract: Objective To explore the heterogeneous frailty trajectories among older survivors of gastric cancer and to examine their influencing factors and prognostic significance. Methods A total of 488 elderly gastric cancer patients admitted to our hospital between June 2020 and June 2022 were selected. Patients ' frailty was assessed by Tilburg frailty indicator (TFI) at hospital admission and at 1, 3, 6, 9, and 12 months after surgery. Growth mixture modeling (GMM) was used to identify distinct frailty trajectory subtypes. Multifactorial logistic regression was used to analyze the factors associated with different frailty trajectory subtypes. Kaplan-Meier survival curves were used to analyze the relationship between different frailty trajectory subtypes and overall patient survival. Results The GMM model identified three subtypes of frailty trajectories: 252 cases (51.6%) of low-degree declining frailty, 124 cases (25.4%) of medium-degree stable frailty, and 112 cases (23.0%) of medium-degree increasing frailty. Multivariate logistic regression analysis showed that age, diabetes, anemia, marital status, individual monthly income, and mini-nutritional assessment short-form (MNS-SF) score were independent predictors of moderate-degree stable frailty (P < 0.05). Age, diabetes, family caregiver, individual monthly income, MNS-SF score, and social support rating scale (SSRS) score were independently associated with the moderate-degree increasing frailty (P < 0.05). Overall survival rate was higher in the low-degree declining frailty than that in the moderate-degree stable frailty and moderate-degree increasing frailty (P < 0.05). Overall survival was higher in the moderate-degree stable frailty than that in the moderate-degree increasing frailty (P < 0.05). Conclusion Elderly gastric cancer survivors exhibit three frailty trajectory subtypes after surgery. These trajectory subtypes are influenced by different clinical and social factors and are closely associated with prognosis.
- Gastric cancer /
- Frailty /
- Older age /
- Trajectory /
- Predictors

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图 1 老年胃癌幸存者的TFI评分轨迹亚型

Figure 1. The TFI score trajectory subtypes of elderly gastric cancer survivors

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图 2 不同虚弱轨迹组老年胃癌幸存者的生存曲线

Figure 2. Survival curves of elderly gastric cancer survivors in different frailty trajectory groups

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表 1 备选GMM中TFI评分拟合结果

Table 1. The fitting results of TFI scores in the alternative GMM

潜在类别个数	LL	AIC	BIC	Class1(%)	Class2(%)	Class3(%)
1	-5 911.53	11 839.06	11 872.59	100.00
2	-4 029.35	8 090.71	8 157.75	74.59	25.41
3	-3 753.25	7 554.50	7 655.07	25.41	43.85	30.74
注：LL为对数似然比。

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表 2 不同虚弱轨迹老年胃癌幸存者临床资料比较

Table 2. Comparison of clinical data of elderly gastric cancer survivors with different frailty trajectories

项目	总体(n=488)	低程度虚弱下降型(n=252)	中程度虚弱平稳型(n=124)	中程度虚弱增长型(n=112)	统计量	P值
年龄(x±s, 岁)	71.91±4.10	71.03±3.81	72.69±4.35^a	73.03±4.05^a	12.790^b	< 0.001
性别[例(%)]					0.009^c	0.995
男性	340(69.7)	176(69.8)	86(69.4)	78(69.6)
女性	148(30.3)	76(30.2)	38(30.6)	34(30.4)
BMI(x±s)	20.51±2.03	20.68±2.19	20.49±1.85	20.38±1.83	0.955^b	0.386
糖尿病[例(%)]	59(12.1)	19(7.5)	22(17.7)^a	18(16.1)^a	10.307^d	0.006
贫血[例(%)]	30(6.1)	9(3.6)	14(11.3)^a	7(6.3)	8.585^c	0.014
高血压[例(%)]	190(38.9)	93(36.9)	48(38.7)	49(43.8)	1.532^c	0.465
房颤[例(%)]	8(1.6)	2(0.8)	3(2.4)	3(2.7)	2.418^c	0.299
低蛋白血症[例(%)]	9(1.8)	1(0.4)	5(4.0)^a	3(2.7)	7.111^d	0.029
婚姻状况[例(%)]					9.395^c	0.009
已婚	421(86.3)	226(89.7)	97(78.2)^a	98(87.5)
其他	67(13.7)	26(10.3)	27(21.8)^a	14(12.5)
教育程度[例(%)]					1.943^d	0.378
小学及以下	251(51.4)	139(55.2)	61(49.2)	51(45.5)
初中	141(28.9)	64(25.4)	39(31.5)	38(33.9)
高中/中专	52(10.7)	26(10.3)	12(9.7)	14(12.5)
大专/本科及以上	44(9.0)	23(9.1)	12(9.7)	9(8.0)
肿瘤分期[例(%)]					3.249^d	0.197
Ⅰ期	168(34.4)	94(37.3)	39(31.5)	35(31.3)
Ⅱ期	68(13.9)	38(15.1)	18(14.5)	12(10.7)
Ⅲ期	252(51.6)	120(47.6)	67(54.0)	65(58.0)
吸烟[例(%)]	173(35.5)	95(37.7)	42(33.9)	36(32.1)	1.227^c	0.541
饮酒[例(%)]	325(66.6)	170(67.5)	80(64.5)	75(67.0)	0.333^c	0.847
家庭照顾者[例(%)]					8.374^c	0.015
主要	114(23.4)	55(21.8)	22(17.7)	37(33.0)^a
非主要	374(76.6)	197(78.2)	102(82.3)	75(67.0)^a
个人月收入[例(%)]					21.552^c	< 0.001
< 1 000元	243(49.8)	100(39.7)	77(62.1)^a	66(58.9)^a
≥1 000元	245(50.2)	152(60.3)	47(37.9)^a	46(41.1)^a
MNA-SF评分(x±s, 分)	8.01±2.82	8.58±2.86	7.83±2.47^a	6.91±2.78^a	14.636^b	< 0.001
SSRS评分(x±s, 分)	42.28±10.05	43.66±8.11	41.85±12.55	39.65±10.42^a	6.458^b	0.002
注：与低程度虚弱下降型比较，^aP＜0.05。^b为F值，^c为χ²值, ^d为U值。

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表 3 中程度虚弱平稳型老年胃癌幸存者影响因素的多因素logistic回归分析

Table 3. Multivariate logistic regression analysis of influencing factors for middle degree weakness and stable condition elderly gastric cancer survivors

变量	B	SE	Waldχ²	OR(95% CI)	P值
年龄	0.102	0.030	11.549	1.108(1.044~1.175)	0.001
糖尿病	0.814	0.363	5.021	2.257(1.107~4.602)	0.025
贫血	1.354	0.470	8.314	3.874(1.543~9.725)	0.004
低蛋白血症	1.932	1.129	2.928	6.902(0.755~63.083)	0.087
已婚	-0.842	0.333	6.397	0.431(0.224~0.827)	0.011
个人月收入≥1 000元	-1.061	0.249	18.199	0.346(0.213~0.564)	＜0.001
MNA-SF评分	-0.112	0.046	5.848	0.894(0.817~0.979)	0.016

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表 4 中程度虚弱增长型老年胃癌幸存者影响因素的多因素logistic回归分析

Table 4. Multivariate logistic regression analysis of influencing factors for middle-grade weakness-enhanced elderly gastric cancer survivors

变量	B	SE	Waldχ²	OR(95% CI)	P值
年龄	0.139	0.034	16.532	1.149(1.074~1.228)	＜0.001
糖尿病	0.993	0.420	5.596	2.699(1.186~6.142)	0.018
家庭主要照顾者	0.968	0.301	10.322	2.634(1.459~4.755)	0.001
个人月收入≥1 000元	-1.042	0.265	15.443	0.353(0.210~0.593)	＜0.001
MNA-SF评分	-0.270	0.053	25.875	0.764(0.688~0.847)	＜0.001
SSRS评分	-0.055	0.015	13.872	0.946(0.919~0.974)	＜0.001

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