Long-term results of operation for non-small cell lung cancer in the elderly

doi:10.1016/0003-4975(90)91119-V

The Annals of Thoracic Surgery

Volume 50, Issue 6, December 1990, Pages 919-922

https://doi.org/10.1016/0003-4975(90)91119-V Get rights and content

Abstract

We surgically treated 185 patients with non-small cell lung cancer who were 70 years old or older. The operative mortality rate was 3%, and the 5-year survival rate was 48%. The mortality and prognosis were similar to those in younger patients. The number of elderly patients who smoked heavily or who had ventilatory defects was high, but the incidence of pneumonectomy was low. There were no differences based on age in regard to histological type, TNM classification, and curability. Pulmonary complications occurred in 21% of the elderly patients and were correlated with preoperative pulmonary function and smoking habits. When the elderly are to undergo elective pulmonary resection for lung cancer, the preoperative evaluation of pulmonary function should be thorough, and both preoperative and postoperative physical therapy should be given. If postoperative pulmonary function is predicted to be less than 0.8 L/m² of vital capacity and 0.6 L/m² of forced expiratory volume in 1 second, a limited resection or nonsurgical therapy should be considered.

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Multiple studies demonstrate ECS has a significant impact on prognosis with the majority of studies indicating associated reduced overall survival and greater local and distant recurrence. A comprehensive systematic review of key prognostic factors related to surgically treated non-small cell lung cancer (NSCLC) patients with resected N2-disease from 1980 to 1995, identified four groups [29–32] reporting significantly better survival in patients without ECS, one [33] a trend in this direction, and one [34] without a significant difference [35]. Furthermore, a recent study also found no association of ECS with poor prognosis in NSCLC; however, this was a small retrospective study [36].
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A poor score on the Charlson Comorbidity Index (reflecting a high number and severity of comorbidities) was predictive of major complications following surgery (odds ratio 12.6) [32]. This study and others studies have suggested that the operative and long-term mortality in older adults following surgery for lung cancer are acceptable and not dissimilar from that seen in younger adults [32–34]. Additionally, although post-operative morbidity and mortality are influenced by the type of surgery performed, even larger surgeries such as lobectomy and pneumonectomy can be used for appropriately selected older patients [28,32,35].
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There were conflicting data about the increasing age on the increasing incidence of major complication or postoperative death. A number of studies confirmed15–17 this observation and others18–20 did not found such relationship. Harvey et al.21 reported that significant increased operative mortality did not emerge until the age of 80 years.
To compare survival and outcomes of pulmonary resection for elderly NSCLC patients with that of younger controls in China.
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There were 1304 patients: 652 cases were ≥70. The 5-year OS of elderly was 39%; that of the controls was 45% (p = 0.06). Operative mortality rate between elderly and the controls was similar (9/652 vs 4/652 p = 0.16) but the short-term death within 2 months after the surgeries were different (23/652 vs 7/652 p = 0.003). The elderly with lobectomy had a worse 5-year OS than controls (42% vs 46% p = 0.05), but the 5-year OS was similar for patients who received pneumonectomy (24% vs 36% p = 0.40) and the limited resections (46% vs 39% p = 0.27). The 5-year OS in patients who received adjuvant chemotherapy were similar (49% vs 44% p = 0.10).
Elderly have the similar long-term OS with the controls. They should not be denied the curative surgery and adjuvant chemotherapy based on their chronologic age. However, elderly patients had a higher risk of short-term death after the surgery, which suggests that elderly be given more intensive care after the surgery.
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^☆: This work was supported by a grant from the Fukuoka Cancer Society.

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Original articleLong-term results of operation for non-small cell lung cancer in the elderly☆

Abstract

Ann Thorac Surg

Ann Thorac Surg

J Thorac Cardiovasc Surg

Thorax

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Am J Clin Pathol

J Am Stat Assoc

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Surg Gynecol Obstet

Cancer Bull

Vital statistics

Vital statistics

Original article
Long-term results of operation for non-small cell lung cancer in the elderly☆