A retrospective analysis of short and long-term survival after curative pulmonary resection for lung cancer in elderly patients

Schneider, Thomas; Pfannschmidt, Joachim; Muley, Thomas; Reimer, Peter; Eberhardt, R; Herth, Felix J.F.; Dienemann, Hendrik; Hoffmann, Hans

doi:10.1016/j.lungcan.2008.02.022

Cited by 29 publications

(24 citation statements)

References 28 publications

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“…5,[29][30][31] Because age changes immunity of aged people, age contributes to the increased incidence and mortality of most cancers. In conformity with the previous reports, 12,30) the OS of current study showed comparable between elderly patients and their younger counterparts. On the other hand, the PFS and DRS in the elderly group showed longer than their younger counterparts.…”

Section: Discussionsupporting

confidence: 93%

“…Thus age 75 years was commonly accepted as critical cut-off point for pulmonary resection. [11][12][13] Along with aging population, increasing numbers of elderly patients with lung cancer led to significant growth in the demand of surgical intervention for the elderly. 1,14,15) Thus, in this study, we retrospectively collected patients with non-small cell lung cancer (NSCLC) and receiving curative resection to analyze the outcomes of treatment in the elderly and to determine the impacts of age on survival.…”

Section: Introductionmentioning

confidence: 99%

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Surgery for Elderly Lung Cancer

Liu

Huang

et al. 2013

ATCS

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Objective: There are still controversies about the surgical benefits for elderly lung cancer. The aims of this study were to assess impacts of aging for non-small cell lung cancer (NSCLC) following pulmonary resection. Methods: A retrospective study was undertaken for patients operated at a curative intent from January 1998 to October 2008. Patients were divided into two groups: Group 1 consisted of patients aged at least 75 years old, and group 2 were patients less than 75 years old. Perioperative characteristics and details, hospital courses, surgery-related morbidities, surgical mortality, and survival were compared between groups. Results: Of 442 eligible patients, 73 patients (16.5%) were in group 1 (mean age 78.3 years) and 369 (83.5%) patients were in group 2 (mean age 62.5 years). The following data were compared with statistical significance: hospital stay (17.8 vs. 8.9 days), mortality rate (8.2 vs. 2.2%), morbidity rate (26.0 vs. 13.3%), and length in intensive care unit (5.7 vs. 3.2 days). The main causes for morbidities in group 1 showed cardiopulmonaryrelated. Tumor stage without considering age had statistically significant influence on survival. Survivals of two groups were comparative. (p = 0.10) Intriguingly, the disease-related survival (28.3 months; p = 0.008) and progression-free survival (25.0 months; p <0.001) in group 1 were significantly better than group 2 (20.2 and 12.2 months). Conclusions: Although operation for NSCLC in the elderly patients causes more complications, especially in the cardiopulmonary system, their outcome showed better than their younger counterparts. Pulmonary resection for elderly patients may get longer disease control. Elderly patients with physical fit for surgery should not be considered as a contraindication to pulmonary resection based on age alone.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Surgery for Elderly Lung Cancer

Liu

Huang

et al. 2013

ATCS

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“…Schneider found that an impaired performance status had a significant negative impact on survival in subjects >75 years. 15) We think the fragility and poorer life expectation of the elderly in this study were the contributing factor so that the radical lobectomy failed to achieve the cancer benefit for the elderly as for the control. They just died early after the radical intervention no matter if the tumors relapsed.…”

Section: Discussionmentioning

confidence: 76%

Outcome of VATS Lobectomy for Elderly Non-Small Cell Lung Cancer: A Propensity Score-Matched Study

Sui

Zhao

Wang

et al. 2015

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Purpose: To analyze the short-term and long-term outcome of video-assisted thoracic surgery (VATS) lobectomy for elderly patients with non-small cell lung cancer. Methods: 105 patients aged ≥75 years with resected non-small cell lung cancer were matched with 105 younger patients by propensity score. Survival rates were calculated by the Kaplan-Meier method. The cumulative incidence functions of conditional survival rate according to the age of the patients were calculated by competing risk analysis. Results: patients ≥75 years was associated with higher postoperative complication rate (p <0.001), but similar perioperative death rate (p = 0.006). Patients ≥75 years were less likely to receive adjuvant chemotherapy (p <0.001). The 5-year overall survival rates were 54.6% for patients ≥75 years and 74.1% for patients <75 years (p = 0.001). No difference was seen in disease-free survival rate (59.5% vs. 71.9% respectively = 0.117). The cumulative incidence functions of 5-year cancer-specific death were similar between the two groups (28.7% vs. 24.6% respectively, p = 0.106). The cumulative incidence functions of 5-year non-cancer-specific death was significantly higher in the elderly group (18.7% vs. 1.0%, p <0.001). Conclusions: VATS lobectomy for non-small-cell lung cancer in patients ≥75 years were feasible with increased morbidity but similar mortality. The resected elderly patients were more frequently associated with non-cancer-specific death.

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“…Elderly patients, particularly those with multiple comorbidities and an impaired performance status, are at high operative risk and do not have the same survival benefits observed in younger patients. 2,3,20 Several factors that predict for prolonged length of hospital stay (PLOS) have been identified, 36 and our cohort of mainly elderly men who were smokers with COPD and had high average comorbidity scores, by definition, have a high PLOS score. Hospitalization is the single largest component of net costs for elderly patients with cancer during any phase of care, and it is estimated that more than half the cost of initial lung cancer care consists of hospitalization costs.…”

Section: Discussionmentioning

confidence: 99%

“…16 Nearly 70% of elderly patients with NSCLC in the National Cancer Institute's Surveillance, Epidemiology, and End Results database were not treated according to guidelines, 17 and concerns about increased surgical morbidity and mortality were a common reason for deferring from guideline-recommended therapy, although older patients tend to present with earlier stage lung cancer. [18][19][20] Despite this, surgery still is the recommended therapy for the elderly, because realistic nonsurgical treatment options were lacking until the emergence of SRT in recent years.…”

Section: Discussionmentioning

confidence: 99%

Stage I nonsmall cell lung cancer in patients aged ≥75 years

Haasbeek

Lagerwaard

Antonisse

et al. 2009

Cancer

165

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BACKGROUND:The number of patients aged !75 years who present with a stage I nonsmall cell lung cancer (NSCLC) is increasing. Elderly patients often have significant comorbidity and may be unfit for surgery. Furthermore, surgery in the elderly is associated with increased mortality and morbidity. In this study, the authors evaluated the outcomes of stereotactic radiotherapy (SRT) in elderly patients. METHODS: Since 2003, 203 tumors in 193 patients aged !75 years were treated using SRT (118 T1 tumors, 85 T2 tumors). The median patient age was 79 years, 80% of patients were considered medically inoperable, and 20% of patients declined surgery. The median Charlson comorbidity score was 4, and severe chronic obstructive pulmonary disease (Global Initiative for Chronic Obstructive Lung Disease Class III or greater) was present in 25% of patients. Risk-adapted SRT schemes were used with the same total dose of 60 grays in 3 fractions (33%), 5 fractions (50%), or 8 fractions (17% of patients), depending on the patient's risk for toxicity. RESULTS: SRT was well tolerated, and all but 1 patient completed treatment. Survival rates at 1 year and 3 years were 86% and 45%, respectively. Survival was correlated with performance score (P ¼ .001) and pre-SRT lung function (P ¼ .04). The actuarial local control rate at 3 years was 89%. Acute toxicity was uncommon, and late Radiation Therapy Oncology Group grade !3 toxicity was observed in <10% of patients. CONCLUSIONS: SRT achieved high local control rates with minimal toxicity in patients aged !75 years despite their significant medical comorbidities. These results indicated that more active diagnostic and therapeutic approaches are justified in elderly patients and that SRT should be considered and discussed as a curative treatment alternative. Cancer 2010;116:406-14.

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A retrospective analysis of short and long-term survival after curative pulmonary resection for lung cancer in elderly patients

Cited by 29 publications

References 28 publications

Surgery for Elderly Lung Cancer

Surgery for Elderly Lung Cancer

Outcome of VATS Lobectomy for Elderly Non-Small Cell Lung Cancer: A Propensity Score-Matched Study

Stage I nonsmall cell lung cancer in patients aged ≥75 years

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