Survival and Outcomes of Pulmonary Resection for Non-Small Cell Lung Cancer in the Elderly: A Nested Case-Control Study

doi:10.1016/j.athoracsur.2006.02.085

The Annals of Thoracic Surgery

Volume 82, Issue 2, August 2006, Pages 424-430

Presented at the Forty-second Annual Meeting of The Society of Thoracic Surgeons Chicago, IL, Jan 30–Feb 1, 2006. Winner of the Geriatric Patient Care Award.

https://doi.org/10.1016/j.athoracsur.2006.02.085 Get rights and content

Background

We assessed the morbidity, mortality, and long-term survival of pulmonary resection for non-small cell lung cancer (NSCLC) in elderly patients in three subgroups: 70 years or greater, 75 years or greater, and 80 years or greater.

Methods

A nested case-control study over a 5-year period using an electronic prospective database (n = 6,450) of patients with NSCLC who underwent complete resection. Patients 70 years or older, 75 years or older, and 80 years or older were matched 1:1 to younger controls for stage, pulmonary function, performance status, and type of pulmonary resection.

Results

There were 726 patients: 363 were 70 years of age or older (191 patients were 70 to 74 years old, 121 were 75 to 79, and 51 patients were 80 or older). There were 363 patients younger than 70 years of age. There was no significant difference in length of stay, major morbidity, or operative mortality between any of the elderly groups and the younger controls. However, elderly patients who received neoadjuvant therapy had three times the risk of developing major morbidity (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.14 to 7.41). There was a statistically significant better 5-year survival in elderly patients with stage I NSCLC (78% vs 69%, p = 0.01); however, survival was similar for all other stages.

Conclusions

Elderly patients with NSCLC should not be denied pulmonary resection based on chronologic age. Their short-term risks and long-term survival are similar to younger patients. Additionally, there seems to be no increased risk in selected octogenarians. However, elderly patients had double the risk for developing major morbidity after resection if they underwent neoadjuvant therapy.

Section snippets

Patients

This is a nested case-control study between January 1998 and January 2005. A case-control analysis was used to determine and evaluate preoperative risk factors and a matched cohort analysis was used to examine differences in survival. A consecutive series of elderly patients who met this study’s entry criteria comprised the patients in one part of this study. Younger patients (less than 70 years of age) who had complete pulmonary resection (R0) during the time interval of the study were

Results

There were 726 patients; 363 were elderly and 363 patients served as younger matched controls. Among the elderly, 191 patients were 70 to 74 years old, 121 were between 75 and 79, and 51 were octogenarians. Controls were matched from the database based on FEV₁% of predicted, ECOG performance status, stage, type of tumor, and the type of pulmonary resection performed.

Table 1 compares the patient characteristics of the elderly with their younger counterparts. The male to female ratio differs

Comment

Lung cancer remains a pandemic and is the most common cause of cancer death in the United States and world wide. In 2005, there will be about 173,000 new cases of lung cancer, accounting for 13% of all cancers [10].

The average age of patients diagnosed with lung cancer is 63 years. Less than 3% of patients who develop lung cancer are 45 years or younger [10]. Given these facts and the increasing age of the population of the United States, more and more elderly Americans will present to their

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Original articleGeneral thoracicSurvival and Outcomes of Pulmonary Resection for Non-Small Cell Lung Cancer in the Elderly: A Nested Case-Control Study

Background

Methods

Results

Conclusions

Section snippets

Patients

Results

Comment

J Thorac Cardiovasc Surg

Ann Thorac Surg

Ann Thorac Surg

Chest

Lung Cancer

Chest

Ann Oncol

J Thorac Cardiovasc Surg

Original article
General thoracic
Survival and Outcomes of Pulmonary Resection for Non-Small Cell Lung Cancer in the Elderly: A Nested Case-Control Study