Comprehensive evaluation of older patients with suspected malignancy: 5-year experience of a tertiary geriatric inpatient unit

Geriatric cancer population is growing. Both cancer and geriatric conditions are associated with some degree of inflammatory burden. To comprehensively present our five years of experience in patients with suspicion of a malignancy, signs and symptoms that are more prominent as indicator of malignancies, conditions that cause malignancy-like symptoms, and common malignancies and newly diagnosed malignancies in geriatric patients with a history of cancer. Patients hospitalized with suspected malignancy in a geriatric inpatient unit were included. Demographic data, hospitalization symptoms, clinical findings, smoking history, laboratory and further examinations, comprehensive geriatric assessment scores, length of hospital stay and discharge diagnoses were examined. Endoscopy and colonoscopy findings were also recorded. Of the 1,104 patients hospitalized for various reasons in the five-year period, 197 (106 women) were suspected of having a malignancy. Mean age was 78.22 ± 7.27. A total of 65 (33%) patients were diagnosed with a malignancy. Amount of smoking (pack/year) and geriatric depression scale (GDS) scores were significantly higher in malignant group (<i>p</i> = .009; <i>p</i> &lt; .001; respectively). Of the hospitalization symptoms, frequency of lumbar-hip-back pain was significantly higher in the malignant group (<i>p</i> = .043). The three most common cancers were hematologic (32%), lung (15%), and gastrointestinal cancers (15%). Gastritis was the most common pathological finding from gastroscopies (58%), and adenoma from colonoscopies (24%). Malignancies were detected in 40% of patients with a history of malignancy, and 55% of the newly detected malignancies were new primaries. Immunoglobulin G4-related disease was one of the detected interested benign conditions. The frequency and presentation patterns of malignancies may differ in older adults. Depressive symptoms are common in geriatric cancer patients. Geriatric patients with a history of malignancy should be evaluated in detail for new primary malignancies.

老年癌症患者群体规模持续扩大。癌症与老年病症均与一定程度的炎症负荷相关。为全面总结五年来针对疑似恶性肿瘤老年患者的诊疗经验，本研究聚焦于可作为恶性肿瘤提示信号的典型体征与症状、引发类恶性肿瘤症状的相关疾病，以及有癌症病史老年患者的常见恶性肿瘤与新发确诊恶性肿瘤情况。研究纳入老年住院单元内收治的疑似恶性肿瘤患者，收集并分析受试者的人口学资料、住院期间症状、临床体征、吸烟史、实验室及其他辅助检查结果、老年综合评估评分、住院时长与出院诊断，同时记录内镜及结肠镜检查结果。在五年间因各类原因住院的1104例患者中，共197例（其中女性106例）疑似罹患恶性肿瘤，受试者平均年龄为78.22±7.27岁。其中65例（占比33%）最终确诊为恶性肿瘤。恶性肿瘤组的吸烟量（包·年）及老年抑郁量表（Geriatric Depression Scale, GDS）评分均显著高于非恶性组（分别为p=0.009、p<0.001）。在住院相关症状中，恶性肿瘤组患者腰髋部疼痛的发生率显著更高（p=0.043）。最常见的三类恶性肿瘤依次为血液系统肿瘤（32%）、肺癌（15%）及胃肠道肿瘤（15%）。胃镜检查中最常见的病理结果为胃炎（占比58%），结肠镜检查中最常见的病理结果为腺瘤（占比24%）。有癌症病史的患者中，40%检出新发恶性肿瘤，其中55%为原发性新发肿瘤。免疫球蛋白G4相关疾病（Immunoglobulin G4-related disease）为本次研究检出的一类值得关注的良性疾病。老年人群中恶性肿瘤的发生频率与临床表现模式或存在差异；抑郁症状在老年癌症患者中较为常见；有癌症病史的老年患者需针对原发性新发肿瘤进行详细评估。