Outcomes following resection of non‐small cell lung cancer in octogenarians

Abstract

Background: The treatment of choice for early stage non-small cell lung cancer (NSCLC) is surgical resection. Little is known about the short-and long-term outcomes among very elderly patients. We sought to determine predictors of short-and long-term survival among octogenarians undergoing curative-intent resection for NSCLC in Victoria, Australia. Methods: We retrospectively reviewed data from all patients aged ≥80 years who underwent curative-intent resection for NSCLC over 12 years (January 2005-December 2016) across five tertiary centres. We examined effect of age, stage of disease, extent of surgery and lung function on short-and long-term survival. Results: Two hundred patients aged ≥80 years underwent curative-intent resections. Mortality at 30 and 120 days was 2.9% and 5.9%, respectively. Increased early mortality was observed among those ≥83 years, at 30 days (6.8% versus 0.8%, P = 0.044) and 120 days (12.2% versus 2.3%, P = 0.0096). Early mortality was highest among patients ≥83 years requiring lobectomy, compared to sub-lobar resection at 120 days (17% versus 3.8%, P = 0.019). Long-term survival was predicted by age and stage of disease. Among patients with Stage I disease aged <83 years, lobectomy was associated with superior 5-year survival, compared to sub-lobar resection (83% versus 61%, P = 0.02). Conclusion: In carefully selected elderly patients undergoing curative-intent resection of early stage NSCLC, both short-and long-term outcomes appear consistent with younger historical cohorts. Early mortality was associated with lobectomy in those with advanced age. Older patients undergoing lobectomy appeared to be at highest risk for early mortality, while younger patients with Stage I disease undergoing at least lobectomy appear to have the best long-term survival.

Novel systemic inflammation response index to predict prognosis after thoracoscopic lung cancer surgery: a propensity score‐matching study

“…Current evidence recognizes that systemic inflammatory response, which is featured by changes in peripheral biomarkers and alterations in levels of inflammation‐linked proteins, frequently accompany with numerous cancer patients and further promote carcinomatous pathogenesis and progression . Systemic inflammation indicated by a range of circulating biochemical markers, such as the elevated neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR) and lymphocyte‐to‐monocyte ratio (LMR) and the decreased serum albumin (sAlb) and haemoglobin levels, has been reported to predict unfavourable cancer prognosis . These biomarkers can provide readily available and objective information to help oncologists to estimate patient outcomes since they are easily obtained with low healthcare costs in routine clinical practice …”

“…3 Systemic inflammation indicated by a range of circulating biochemical markers, such as the elevated neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR) and the decreased serum albumin (sAlb) and haemoglobin levels, has been reported to predict unfavourable cancer prognosis. 3,4 These biomarkers can provide readily available and objective information to help oncologists to estimate patient outcomes since they are easily obtained with low healthcare costs in routine clinical practice. 3 Recently, a novel inflammatory indicator comprising continuous variables of peripheral neutrophil, lymphocyte and monocyte counts, termed systemic inflammation response index (SIRI), was first developed on patients receiving chemotherapy for advanced pancreatic cancer, showing a potent prognostic significance.…”

Bronchoscopic Thermal Vapour Ablation for Localized Cancer Lesions of the Lung: A Clinical Feasibility Treat-and-Resect Study

“…In physiologically frail patients, bronchoscopic ablation may allow diagnosis (using rapid on-site evaluation [21]), staging [22], and treatment to be completed in a single procedure. In addition to an improved safety profile, this is likely to be more cost-effective than existing modalities [23], especially in older patients who experience higher rates of morbidity and mortality following resection [24].…”

Excess mortality and undertreatment in elderly lung cancer patients: treatment nihilism in the modern era?

“…Careful patient selection for surgical resection of early stage disease in the elderly suggests that resection can also be performed with short and long-term outcomes consistent with younger cohorts, where sub-lobar resection appears to provide better short-term survival and lobectomy better long-term survival [ 27 , 28 ].…”