Lobectomy Provides the Best Survival for Stage I Lung Cancer Patients Despite Advanced Age

Chan, Edward Y.; Amirkhosravi, Farshad; Nguyen, Duc T.; Chihara, Ray; Graviss, Edward A.; Kim, Min P.

doi:10.1016/j.athoracsur.2022.03.031

Cited by 11 publications

(5 citation statements)

References 12 publications

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“…Based on these findings, RCS 1 patients could mean a decreased concentration of IL-6 and low counts of CTCs or CSCs and also a low mutual promotion between them, which could have a superior outcome than the RCS 2 or 3 patients. Additionally, the prognostic value of other parameters including age [ 58 ], gender [ 58 ], micropapillary and solid patterns [ 6 ], type of resection [ 58 , 59 ], and smoke and alcohol [ 60 ] have been under extensive study in stage I lung cancer, and hypertension was also found contribute to prognosis in lung cancer [ 61 ]. It was suggested that male patients smoke in particular after diagnosis correlated with poor survival in stage I cases [ 58 , 60 ].…”

Section: Discussionmentioning

confidence: 99%

A combined preoperative red cell distribution width and carcinoembryonic antigen score contribute to prognosis prediction in stage I lung adenocarcinoma

Lin

et al. 2023

World J Surg Onc

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Aims Hematological markers that can be used for prognosis prediction for stage I lung adenocarcinoma (LUAD) are still lacking. Here, we examined the prognostic value of a combination of the red cell distribution width (RDW) and carcinoembryonic antigen (CEA), namely, the RDW-CEA score (RCS), in stage I LUAD. Materials and methods A retrospective study with 154 patients with stage I LUAD was conducted. Patients were divided into RCS 1 (decreased RDW and CEA), RCS 2 (decreased RDW and increased CEA, increased RDW and decreased CEA), and RCS 3 (increased RDW and CEA) subgroups based on the best optimal cutoff points of RDW and CEA for overall survival (OS). The differences in other clinicopathological parameters among RCS subgroups were calculated. Disease-free survival (DFS) and OS among these groups were determined by Kaplan–Meier analysis, and risk factors for outcome were calculated by a Cox proportional hazards model. Results Seventy, 65, and 19 patients were assigned to the RCS 1, 2, and 3 subgroups, respectively. Patients ≥ 60 years (P < 0.001), male sex (P = 0.004), T2 stage (P = 0.004), and IB stage (P = 0.006) were more significant in the RCS 2 or 3 subgroups. The RCS had a good area under the curve (AUC) for predicting DFS (AUC = 0.81, P < 0.001) and OS (AUC = 0.93, P < 0.001). The DFS (log-rank = 33.26, P < 0.001) and OS (log-rank = 42.05, P < 0.001) were significantly different among RCS subgroups, with RCS 3 patients displaying the worst survival compared to RCS 1 or 2 patients. RCS 3 was also an independent risk factor for both DFS and OS. Conclusions RCS is a useful prognostic indicator in stage I LUAD patients, and RCS 3 patients have poorer survival. However, randomized controlled trials are needed to validate our findings in the future.

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Section: Discussionmentioning

confidence: 99%

A combined preoperative red cell distribution width and carcinoembryonic antigen score contribute to prognosis prediction in stage I lung adenocarcinoma

Lin

et al. 2023

World J Surg Onc

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“…Most patients in the surgery group in our study received either lobectomy (63.4%) or wedge resection (27.5%). Chan et al [ 13 ] believes that lobectomy provided better 5-year survival compared with sublobar resection regardless of the age in octogenarians with pathologic stage I lung cancer. Yet the JACS1303 study [ 14 ] showed that wedge resection might be equivalent to lobectomy or segmentectomy in selected octogenarians or older with early-stage NSCLC who can tolerate lobectomy.…”

Section: Discussionmentioning

confidence: 99%

Surgery versus radiotherapy in octogenarians with stage Ia non‑small cell lung cancer: propensity score matching analysis of the SEER database

Liu

Zhang

et al. 2022

BMC Pulm Med

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Objectives To compare overall survival (OS) and cancer-specific survival (CSS) outcomes of surgery with radiotherapy in octogenarians with stage Ia non-small cell lung cancer (NSCLC). Materials and methods Patients aged ≥ 80 years with clinical stage Ia (T1N0M0) NSCLC between 2012 and 2017 were identified from the population-based Surveillance, Epidemiology, and End Results (SEER) database. Patients were assigned into surgery and radiotherapy groups. Multivariate Cox regression analysis was used to identify survival-associated factors. Treatment groups were adjusted by propensity score matching (PSM) analysis while OS and CSS outcomes were compared among groups by Kaplan–Meier analysis. Results A total of 1641 patients were identified, with 46.0% in the surgical group and 54.0% in the radiotherapy group. Compared to surgery, radiotherapy-treated patients were older, later diagnosed, had more often unmarried, more squamous cell carcinoma, more unknown grade and increased tumor sizes. Radiotherapy was associated with a significantly worse OS, compared to surgery (hazard ratio 2.426; 95% CI 2.003–2.939; P < .001). After PSM, OS (P < 0.001) and CSS (P < 0.001) were higher in the surgery group. The 1-, 3-, and 5-year OS rates of surgical and radiotherapy group were 90.0%, 76.9%, 59.9%, and 86.0%, 54.3%, 28.0%, respectively. The 1-, 3-, and 5-year CSS rates of surgical and radiotherapy group were 94.5%, 86.1%, 78.0% and 90.7%, 74.5%, 61.0%, respectively. There were no survival differences between the matched surgery without lymph node examination (LNE) and radiotherapy group, as well as between the matched surgery and radiotherapy who were recommended but refused surgery group. Conclusions In octogenarians with stage Ia NSCLC, surgery with lymph node dissection offers better OS and CSS outcomes than radiotherapy.

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“…Die Selektion alter PatientInnen, die von thoraxchirurgischen Interventionen profitieren, die Identifikation von RisikopatientInnen, bei denen die chirurgische Therapie adaptiertwerdenmuss, und derAusschluss vonHochrisikopatient-Innen sind Herausforderungen, die einer ausführlichen, teils interdisziplinären präoperativen Abklärung bedürfen. Ein steigendes Komorbiditätsprofil gemessen am altersunabhängigen Charlson-Deyo-Index wurde in der Lungenkrebschirurgie als unabhängiger Prädiktor für progrediente Morbidität und Mortalität bei > 80-Jährigen [25] und der reguläre Charlson-Index als Risikofaktor für Langzeitüberleben identifiziert [48]. Unter den Komorbiditäten waren in der Lungenkrebschirurgie vorbestehende Herzerkrankungen [49] und in der Metastasenchirurgie Lungenemphysem [27] und präoperative Arhythmie [26] von hoher Bedeutung.…”

Section: Identifikation Alter Risikopatientinnenunclassified

Chirurgie des alten Menschen – Thoraxchirurgie

Ehrsam

Aigner²

2023

Wien klin Mag

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Hintergrund Eine Vielzahl thoraxchirurgisch relevanter Krankheitsbilder häuft sich mit steigendem Alter. Hohes Alter wird aber häufig als Kontraindikation für kurative Eingriffe oder größere operative Eingriffe per se gesehen. Ziel der Arbeit Darlegung der aktuellen relevanten Studienlage, Ableitung von Empfehlungen zur PatientInnenselektion sowie prä-, peri- und postoperativen Optimierung. Material und Methoden Auswertung der aktuellen Studienlage. Ergebnisse Wie aktuelle Daten zeigen, ist das Alter für die meisten thorakalen Erkrankungen allein kein Grund eine chirurgische Behandlung vorzuenthalten. Bei der Selektion gilt es viel mehr, Komorbiditäten, Gebrechlichkeit, Mangelernährung und kognitive Einschränkungen zu berücksichtigen. Eine Lobektomie oder Segmentresektion bei nichtkleinzelligem Lungenkrebs (NSCLC) im Stadium I kann bei gut selektionierten > 80-jährigen PatientInnen zu akzeptablen bis sogar vergleichbar guten Kurz- und Langzeitergebnissen führen wie bei jüngeren. Ausgewählte > 75-jährige PatientInnen mit NSCLC im Stadium II–IIIA können sogar von einer adjuvanten Chemotherapie profitieren. Nach guter Selektion sind Hochrisikoeingriffe wie eine Pneumonektomie bei > 70-Jährigen und pulmonale Endarteriektomie bei > 80-Jährigen ohne erhöhte Mortalitätsraten möglich. Und auch die Lungentransplantation kann bei gut selektionierten > 70-jährigen PatienInnen zu einem guten Langzeitergebnis führen. Minimal-invasive Operationsverfahren und nichtintubierte Anästhesie tragen zur Risikoreduktion bei marginalen PatientInnen bei. Diskussion In der Thoraxchirurgie ist nicht das numerische Alter, sondern das biologische Alter entscheidend. Zur Optimierung der Selektion, der Eingriffe, der Vor- und Nachbehandlung sowie der Lebensqualität sind angesichts der immer älter werdenden Bevölkerung dringend weitere Studien nötig.

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Lobectomy Provides the Best Survival for Stage I Lung Cancer Patients Despite Advanced Age

Cited by 11 publications

References 12 publications

A combined preoperative red cell distribution width and carcinoembryonic antigen score contribute to prognosis prediction in stage I lung adenocarcinoma

A combined preoperative red cell distribution width and carcinoembryonic antigen score contribute to prognosis prediction in stage I lung adenocarcinoma

Surgery versus radiotherapy in octogenarians with stage Ia non‑small cell lung cancer: propensity score matching analysis of the SEER database

Chirurgie des alten Menschen – Thoraxchirurgie

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