Surgical risk and survival impact of octogenarian lung cancer patients compared to those of younger patients undergoing surgery

Abstract

Background: This study aimed to evaluate the surgical risk and survival rates among octogenarian patients with lung cancer undergoing surgery.Methods: In this retrospective cohort study, we examined the outcomes of lung cancer surgery in octogenarian patients between 2006 and 2019, and compared the outcomes with those of younger patients.We measured the clinical data of age at operation, sex, percentage of vital capacity, forced vital capacity (FVC), forced expiratory volume in 1 second (FEV 1 ), body mass index (BMI), smoking history, preoperative carcinoembryonic antigen (CEA) level, standard uptake value max (SUV max ) of tumor, Charlson comorbidity index (CCI), operative procedure, histology, pathological stage, postoperative complication(s), postoperative hospital mortality, hospital stay, postoperative adjuvant therapy, and observation time. Results:We evaluated 1,260 patients who underwent lung cancer surgeries and assigned them to three groups, according to age: young (<60 years; Y group; n=170), middle-aged (60-79 years; M group; n=958), and old (≥80 years; O group; n=132). The clinical characteristics of the Y/M/O groups revealed that the O group had significantly lower body mass index, higher CCI ≥2, higher percentage of limited surgery, nonadenocarcinoma histology, longer hospital stay, and higher total complication rate (7.6%, 16.2%, and 18.2%, respectively; P<0.05 for all). However, no increased mortality was observed (0.0, 0.7, and 0.0, respectively; P=0.33). The 5-year overall, cancer-specific, and recurrence-free survival rates (%) of the Y/M/O groups in pathological stage I were 91.8/95.4/86.9, 81.9/90.5/82.2, and 71.6/85.1/80.4, respectively (P=0.04, 0.27 and 0.14). Lower body mass index, as well as higher standard uptake value max and pathological stage, were independent negative prognostic factors for overall survival in the O group, of which variables were almost consistent with those of the entire cohort. Conclusions:The oncological survival of patients with stage I lung cancer in the O group was almost equivalent to that of the younger populations, with reasonable postoperative complications based on appropriate surgical indications and procedures. Lower body mass index, reflecting sarcopenia, was notable; perioperative positive nutritional support and rehabilitation might improve overall survival in octogenarians.