Peri- and postoperative morbidity and mortality in elderly patients with non-small cell lung cancer: a matched-pair study

Abstract

Background Reports from case series suggest that operative outcomes are comparable amongst different age groups following surgery with curative intent for non-small cell lung cancer (NSCLC). The purpose of this study was to compare morbidity and mortality after NSCLC surgery in elderly patients (≥ 75 years) versus younger patients (< 75 years) and identify independent predictive risk factors. Methods We identified 2015 patients with postoperative stages IA to IIIA according to AJCC/UICC 7th edition who had undergone NSCLC surgery with curative intent at a single specialized lung cancer center from January 2010 to December 2015. A matched-pair analysis was performed on 227 elderly patients and corresponding 227 younger patients. Short-term surgical outcomes were postoperative morbidity, length of hospital stay, 30-day and 90-day mortality. Long-term operative outcomes were disease-free and overall survival. Results 454 patients were included in the matched-pair analysis. 36% of younger patients developed postoperative complications versus 42% in the elderly (p = 0.163). Age was not significantly associated with the occurrence of postoperative complications. Median length of hospital stay was 14 days in elderly and 13 days in younger patients (p = 0.185). 90-day mortality was 2.2% in younger patients compared to 4% in the elderly (p = 0.424). In the elderly impaired performance status (ECOG ≥ 1) was associated with decreased overall survival (HR = 2.15, CI 1.34–3.46), as were preoperative serum C-reactive protein / albumin ratio ≥ 0.3 (HR = 1.95, CI 1.23–3.11) and elevated preoperative serum creatinine levels ≥ 1.1 mg/dl (HR = 1.84, CI 1.15–2.95). In the younger cohort male sex (HR = 2.26, CI 1.17–4.36), postoperative stage III disease (HR 4.61, CI 2.23–9.54) and preoperative anemia (hemoglobin < 12 g/dl) (HR 2.09, CI 1.10–3.96) were associated with decreased overall survival. Conclusions Preoperative treatment decision-making in the elderly should primarily consider individual assessment of patients’ functional performance and general fitness. Patients should not be excluded from surgery for resectable NSCLC due to advanced age.