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Liu W, Ma S, Shi P, Zhang Y, Li M. Postoperative chemotherapy significantly improves survival of elderly patients with stage IB-II non-small cell lung cancer: A population-based study. Cancer Med 2023. [PMID: 37031456 DOI: 10.1002/cam4.5834] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 02/23/2023] [Accepted: 03/12/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND There is scant evidence-based information about survival benefits of postoperative chemotherapy in elderly patients with early-stage non-small cell lung cancer (NSCLC). The purpose of this study is to compare the overall survival (OS) and cancer-specific survival (CSS) rates of surgery alone versus postoperative chemotherapy in patients aged ≥70 years with stage I-II NSCLC. METHODS Elderly patients aged ≥70 years diagnosed with stage I-II NSCLC were selected from the Surveillance, Epidemiology, and End Results (SEER) database from January 1, 2010 to December 31, 2015. OS and CSS were compared between the two groups utilizing overlap weighting analysis, inverse probability of treatment weight (IPTW), and propensity score matching (PSM). RESULTS Of the 7193 included patients with stage I-II NSCLC who are more than 70 years old, 681 patients (9.5%) received postoperative chemotherapy and 6512 patients (90.5%) received surgery-alone. Median OS was 77 months in postoperative chemotherapy group versus 79 months in surgery-alone group (p = 0.89). The result of IPTW analysis showed the similar results. The probability of patients choosing chemotherapy increased with the AJCC stage and Grade increasing (p < 0.001) and decreased with the growth of age (p < 0.001). The results of subgroup analysis showed that the survival rate of stage IA patients decreased significantly after postoperative chemotherapy (p < 0.01) while the survival rate of stage IB-II patients increased significantly (p < 0.01). At the same time, we found that patients in the postoperative chemotherapy group tended to have better OS than those in the surgery-alone group with the grade and tumor size increasing. CONCLUSION The results of this study indicated that postoperative chemotherapy could significantly improve the survival of stage IB-II NSCLC patients aged ≥70 years, and decrease the survival of stage IA patients.
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Affiliation(s)
- Wujianhong Liu
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Shangshang Ma
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Pingfan Shi
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Yanfei Zhang
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
| | - Ming Li
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China
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2
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Yano T, Hamatake M, Tokunaga S, Okamoto T, Yamazaki K, Miura T, Nagayasu T, Sato M, Fukuyama S, Sugio K. A prospective observational study of postoperative adjuvant chemotherapy for non-small cell lung cancer in elderly patients (≥ 75 years). Int J Clin Oncol 2022; 27:882-888. [PMID: 35212829 DOI: 10.1007/s10147-022-02143-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND To examine the effects of postoperative adjuvant chemotherapy for elderly (≥ 75 years of age) patients with completely resected non-small cell lung cancer (NSCLC), we conducted a multi-institutional and prospective observational study. METHODS Patients were recruited between January 2014 and December 2017, and assigned to two cohort groups based on the patients' choice either to receive postoperative adjuvant chemotherapy (Cohort B) or not (Cohort A). All the patients were observed for 2 years after enrollment. The primary endpoint was the postoperative change of Karnofsky Performance Status (KPS) at 2 years. The secondary endpoints were postoperative recurrence-free survival (RFS) and overall survival (OS) at 2 years, and the completion rate of the adjuvant chemotherapy. RESULTS Two hundred and seventy-two patients were enrolled (Cohort A, n = 225; Cohort B, n = 47). At any time point after surgery, no marked difference of KPS was observed between Cohort B and Cohort A. The RFS at 2 years was 70.8% (95% confidence interval [CI], 64.3-76.4) in Cohort A and 76.0% (95% CI 60.8-85.9) in Cohort B. The OS at 2 years was 85.9% (95% CI 80.4-89.9) in Cohort A and 89.1% (95% CI 75.8-95.3) in Cohort B. The completion rate of planned chemotherapy was 49.9% (95% CI 34.1-63.9%). CONCLUSIONS The elderly patients were not likely to choose to receive postoperative adjuvant chemotherapy; however, no significant adverse effect on postoperative KPS was identified. TRIAL REGISTRATION Clinical Trial Registration ID: UMIN000020736.
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Affiliation(s)
- Tokujiro Yano
- Department of General Thoracic Surgery, National Hospital Organization Beppu Medical Center, 1473 Uchikamado, Beppu, 874-0011, Japan.
| | - Motoharu Hamatake
- Department of Thoracic Surgery, Kitakyushu Municipal Medical Center, Kitakyushu, Japan
| | - Shoji Tokunaga
- Medical Information Center, Kyushu University Hospital, Fukuoka, Japan
| | - Tatsuro Okamoto
- Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Koji Yamazaki
- Department of Thoracic Surgery and Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Takashi Miura
- Department of Thoracic Surgery, Oita City Medical Association's Almeida Hospital, Oita, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Masami Sato
- Department of Thoracic Surgery, Kagoshima University, Kagoshima, Japan
| | - Seiichi Fukuyama
- Department of General Thoracic Surgery, National Hospital Organization Beppu Medical Center, 1473 Uchikamado, Beppu, 874-0011, Japan
| | - Kenji Sugio
- Department of Thoracic and Breast Surgery, Faculty of Medicine, Oita University, Yufu, Japan
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3
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Saftic I, Bille A, Asemota N, Berjon de la Vega L, Routledge T, King J, Phipps KH, Pilling J. Risks and rewards of the surgical treatment of lung cancer in octogenarians. Interact Cardiovasc Thorac Surg 2021; 33:905-912. [PMID: 34436584 DOI: 10.1093/icvts/ivab194] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/13/2021] [Accepted: 06/21/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Surgeons will face an increasing number of octogenarians with lung cancer potentially curable by surgery. The goal of this study was to evaluate short- and long-term outcomes after lung resection. METHODS We performed a single-centre study of consecutive patients ≥80 years old, surgically treated for suspected lung cancer between 2009 and 2016. Age, sex, performance status, lung function, surgical approach, type of lung resection, complications, in-hospital and 30- and 90-day deaths and long-term survival were analysed. RESULTS Two hundred and fifty-seven patients were enrolled. The median age was 82 years (range 80-97). One hundred and thirty-four patients were treated by thoracotomy and 123 by video-assisted thoracic surgery [10 (8.1%) converted]. Two hundred and thirty-two underwent lobar resection and 25 underwent sublobar resection. There were no intraoperative deaths and 9 admissions to the intensive therapy unit; 112 (43.6%) patients suffered complications: More complications occurred after lobar versus after sublobar resections [45.7% vs 24% (P = 0.037)] and in those with chronic obstructive pulmonary disease (COPD) [57.4% vs 40% (P = 0.02)]. The 30-day mortality was 3.9% (n = 10) and the 90-day mortality was 6.22% (n = 16). One hundred and sixty-seven patients died during the study period; patients with non-small-cell lung cancer (n = 233) had a median survival of 46.5 months with 67.2% alive at 2 years and 40.8% at 5 years. Pathological stage and R status were independent prognostic factors for survival. CONCLUSIONS Surgery for malignancies in octogenarians is feasible and safe with good long-term outcomes. The risk of postoperative complications, especially in those with COPD, is high but can be minimized with sublobar resection. Postoperative mortality is acceptable, and long-term survival is primarily governed by lung cancer stage. Age is no reason to deny patients surgery for early-stage disease.
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Affiliation(s)
- Igor Saftic
- Department of Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Andrea Bille
- Department of Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Division of Cancer Studies, King's College London Faculty of Life Sciences & Medicine at Guy's, London, UK
| | - Nicole Asemota
- Department of Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Tom Routledge
- Department of Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Juliet King
- Department of Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Karen Harrison Phipps
- Department of Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - John Pilling
- Department of Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
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4
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Lou X, Sanders A, Wagh K, Binongo JN, Sancheti M, Javidfar J, Pickens A, Fernandez F, Force S, Khullar O. Safety and Feasibility of Thoracoscopic Lung Resection for Non-Small-Cell Lung Cancer in Octogenarians. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 16:68-74. [PMID: 33245249 DOI: 10.1177/1556984520971620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Octogenarians comprise an increasing proportion of patients presenting with non-small-cell lung cancer (NSCLC). This study examines postoperative morbidity and mortality, and long-term survival in octogenarians undergoing thoracoscopic anatomic lung resection for NSCLC, compared with younger cohorts. METHODS We conducted a retrospective review of our institutional Society of Thoracic Surgeons General Thoracic Surgery Database of all patients ≥60 years old undergoing elective lobectomy or segmentectomy for pathologic stage I, II, and IIIA NSCLC between 2009 and 2018. Results were compared between octogenarians (n = 71) to 2 younger cohorts of 60- to 69-year-olds (n = 359) and 70- to 79-year-olds (n = 308). Long-term survival among octogenarians was graphically summarized using the Kaplan-Meier method. Cox regression analysis was used to identify preoperative risk factors for mortality. RESULTS A greater proportion of octogenarians required intensive care unit admission and discharge to extended-care facilities; however, postoperative length of stay was similar between groups. Among postoperative complications, arrhythmia and renal failure were more likely in the older cohort. Compared to the youngest cohort, in-hospital and 30-day mortality were highest among octogenarians. Overall survival among octogenarians at 1, 3, and 5 years was 87.3%, 61.8%, and 50.5%, respectively. On multivariable Cox regression analysis of baseline demographic variables, presence of stroke (hazard ratio [HR] = 28.5, 95% confidence interval [CI]: 6.1 to 132.7, P < 0.001) and coronary artery disease (HR = 2.5, 95% CI: 1.2 to 5.3, P = 0.02) were significant predictors of overall mortality among octogenarians. CONCLUSIONS Thoracoscopic resection can be performed with favorable early postoperative outcomes among octogenarians. Long-term survival, although comparable to their healthy peers, is worse than those of younger cohorts. Further study into preoperative risk stratification and alternative therapies among octogenarians is needed.
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Affiliation(s)
- Xiaoying Lou
- 1371 Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Andrew Sanders
- 1371 Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Kaustubh Wagh
- 1859 Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jose N Binongo
- 1859 Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Manu Sancheti
- 1371 Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Jeffrey Javidfar
- 1371 Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Allan Pickens
- 1371 Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Felix Fernandez
- 1371 Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Seth Force
- 1371 Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Onkar Khullar
- 1371 Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA
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5
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Ijsseldijk MA, Shoni M, Siegert C, Wiering B, van Engelenburg AKC, Tsai TC, Ten Broek RPG, Lebenthal A. Oncologic Outcomes of Surgery Versus SBRT for Non-Small-Cell Lung Carcinoma: A Systematic Review and Meta-analysis. Clin Lung Cancer 2020; 22:e235-e292. [PMID: 32912754 DOI: 10.1016/j.cllc.2020.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 04/21/2020] [Accepted: 04/25/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The optimal treatment of stage I non-small-cell lung carcinoma is subject to debate. The aim of this study was to compare overall survival and oncologic outcomes of lobar resection (LR), sublobar resection (SR), and stereotactic body radiotherapy (SBRT). METHODS A systematic review and meta-analysis of oncologic outcomes of propensity matched comparative and noncomparative cohort studies was performed. Outcomes of interest were overall survival and disease-free survival. The inverse variance method and the random-effects method for meta-analysis were utilized to assess the pooled estimates. RESULTS A total of 100 studies with patients treated for clinical stage I non-small-cell lung carcinoma were included. Long-term overall and disease-free survival after LR was superior over SBRT in all comparisons, and for most comparisons, SR was superior to SBRT. Noncomparative studies showed superior long-term overall and disease-free survival for both LR and SR over SBRT. Although the papers were heterogeneous and of low quality, results remained essentially the same throughout a large number of stratifications and sensitivity analyses. CONCLUSION Results of this systematic review and meta-analysis showed that LR has superior outcomes compared to SBRT for cI non-small-cell lung carcinoma. New trials are underway evaluating long-term results of SBRT in potentially operable patients.
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Affiliation(s)
- Michiel A Ijsseldijk
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Melina Shoni
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Charles Siegert
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, MA
| | - Bastiaan Wiering
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands
| | | | - Thomas C Tsai
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Richard P G Ten Broek
- Division of Surgery, Slingeland Ziekenhuis, Doetinchem, The Netherlands; Division of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Abraham Lebenthal
- Division of Thoracic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Thoracic Surgery, West Roxbury Veterans Administration, West Roxbury, MA; Harvard Medical School, Boston, MA
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6
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Zaatar M, Stork T, Valdivia D, Mardanzai K, Stefani D, Collaud S, Poellen P, Hegedus B, Ploenes T, Aigner C. Minimal-invasive approach reduces cardiopulmonary complications in elderly after lung cancer surgery. J Thorac Dis 2020; 12:2372-2379. [PMID: 32642142 PMCID: PMC7330380 DOI: 10.21037/jtd.2020.03.73] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The number of elderly patients undergoing lung resection for lung cancer is continuously increasing. This study investigates the risk factors for postoperative complications in elderly lung cancer patients and the role of surgical approach in early postoperative outcome. Methods We reviewed all consecutive patients who underwent anatomical resection for early stage T1/2 lung cancer in a curative intent between January 2016 and November 2018 at our institution. Clinical data, postoperative complications, hospital stay and 30- and 90-day mortality were prospectively collected. Results A total of 505 (278 male) patients were included. One hundred ninety patients (38%) were ≥70 years of age. Forty-eight percent (n=241) had thoracotomy, 52% (n=264) were operated with video-assisted or robot-assisted thoracoscopy. Major cardiopulmonary complications were observed in 4.2% (n=21) patients. There was no significant difference in major cardiopulmonary complication rate following minimally invasive surgery between patients above or below 70 years of age (4.3% vs. 2.5%, P=0.47). In contrast, major cardiopulmonary complication rate was significantly higher in elderly thoracotomy patients than in patients below 70 years of age (9.9% vs. 2.6%, P=0.035). Elderly patients operated minimally invasive had a significantly shorter hospital stay compared to open approach (8.1 vs. 11.9 days, P<0.0001). Thirty- and 90-day mortality was comparable with 1.4% and 1.5%, respectively. Conclusions Pulmonary resection for lung cancer in elderly patients is safe and can be performed with a low morbidity and mortality. However, our results indicate that minimal invasive surgery leads to reduced postoperative complications especially in elderly and should be the preferred approach.
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Affiliation(s)
- Mohamed Zaatar
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Theresa Stork
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Daniel Valdivia
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Khaled Mardanzai
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Dirk Stefani
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Stéphane Collaud
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Pauline Poellen
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Balazs Hegedus
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Till Ploenes
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, Ruhrlandklinik, University Medicine Essen, Essen, Germany
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7
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Fong LS, Ko V, Mclaughlin A, Okiwelu NL, Newman MA, Passage J, Sanders LHA, Joshi PV. Outcomes of video-assisted thoracoscopic surgery lobectomy in septuagenarians. ANZ J Surg 2020; 90:752-756. [PMID: 32348031 DOI: 10.1111/ans.15788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Spread of technology and increased surveillance have led to more patients with lung cancers being identified than ever before. Increasingly, patients from the elderly population are referred for surgery; however, many studies do not focus on this patient group. We reviewed the outcomes of septuagenarians who underwent lobectomy via an open thoracotomy (OT) or video-assisted thoracoscopic surgery (VATS) approach to determine whether the VATS approach would result in superior post-operative outcomes. METHODS Between January 2010 and June 2016, a total of 96 patients aged 70 years or older underwent a lobectomy for non-small cell lung carcinoma. Patients who underwent resection for metastatic disease, small cell lung cancer or neuroendocrine tumour were excluded. Demographic details, early and late post-operative outcomes including post-operative arrhythmia, myocardial infarction, respiratory failure, cerebrovascular events, infection, prolonged air leak, delirium, readmission and 30-day mortality were studied. Mean follow-up duration was 23 ± 19.1 months. RESULTS Seventy-five patients underwent lobectomy via a VATS approach and 21 patients underwent lobectomy via an OT approach. There was no 30-day mortality and no difference in overall survival between the two techniques (P = 0.25). There was no significant difference between the two techniques with regard to post-operative stroke, myocardial infarction, atrial fibrillation, pneumonia, delirium or bronchopleural fistula. VATS patients had a significantly shorter mean hospital length of stay (VATS 4.7 days, OT 9.3 days, P = 0.005). CONCLUSION Septuagenarians with non-small cell lung carcinoma can successfully undergo curative lung resection with a low incidence of post-operative complications.
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Affiliation(s)
- Laura S Fong
- Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Viktor Ko
- Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Aden Mclaughlin
- Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | | | - Mark A Newman
- Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,School of Medicine, The University of Western Australia, Perth, Western Australia, Australia
| | - Jurgen Passage
- Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,School of Medicine, The University of Notre Dame, Fremantle, Western Australia, Australia.,Department of Cardiothoracic Surgery, The Baird Institute, Sydney, New South Wales, Australia
| | - Lucas H A Sanders
- Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Pragnesh V Joshi
- Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,School of Medicine, The University of Western Australia, Perth, Western Australia, Australia.,School of Medicine, The University of Notre Dame, Fremantle, Western Australia, Australia.,Department of Cardiothoracic Surgery, The Baird Institute, Sydney, New South Wales, Australia
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8
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Cohen C, Al Orainy S, Pop D, Poudenx M, Otto J, Berthet JP, Venissac N, Mouroux J. Anatomical pulmonary resections for primary lung cancer in octogenarians within a dedicated care protocol. J Thorac Dis 2019; 11:3732-3737. [PMID: 31656645 DOI: 10.21037/jtd.2019.09.30] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background The aim of this study was to assess the feasibility of major pulmonary resection for a limited non-small cell lung cancer (NSCLC) in octogenarians within a dedicated care protocol. Methods We retrospectively analyzed data of 55 octogenarians operated on in a single institution between January 2005 and December 2016. They were all included in a specific care protocol with systematic geriatric assessment and adaptation of the peri-operative care. We describe the results of post-operative morbidity, mortality, and survival after anatomical resection and radical lymphadenectomy. Results Mean age at the time of surgery was 82.1 years (80-86 years). Median Charlson's comorbidity score was 0 (0-3). All patients were classified Balducci 1 or 2. We performed 2 pneumonectomies (3%), 3 bilobectomies (5%), 47 lobectomies (85%) and 3 segmentectomies (5%). The median hospital stay was 11.5 days (7-31 days). The 30-day mortality rate was 3%. The total of relevant clinical complications (Clavien 3 to 5) was 16% (n=9). The Overall Survival at one, three and five years were, respectively: 83% (95% CI: 75-95%); 70% (95% CI: 56-87%); 58% (95% CI: 43-79%). Conclusions Major pulmonary resection for primary lung cancer in octogenarians seems to be safe, with an acceptable morbidity, mortality and long-term survival rate, when processing to rigorous selection of the patients, within a dedicated care protocol.
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Affiliation(s)
- Charlotte Cohen
- Department of Thoracic Surgery, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur, 06001 Nice Cedex 1, France
| | - Saleh Al Orainy
- Department of Thoracic Surgery, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur, 06001 Nice Cedex 1, France
| | - Daniel Pop
- Department of Thoracic Surgery, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur, 06001 Nice Cedex 1, France
| | - Michel Poudenx
- Department of Thoracic Surgery, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur, 06001 Nice Cedex 1, France.,Department of Thoracic Oncology, Centre Antoine Lacassagne, 06300 Nice, France
| | - Josiane Otto
- Department of Thoracic Oncology, Centre Antoine Lacassagne, 06300 Nice, France
| | - Jean-Philippe Berthet
- Department of Thoracic Surgery, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur, 06001 Nice Cedex 1, France
| | - Nicolas Venissac
- Department of Thoracic Surgery, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur, 06001 Nice Cedex 1, France
| | - Jérome Mouroux
- Department of Thoracic Surgery, Centre Hospitalier Universitaire de Nice, Hôpital Pasteur, 06001 Nice Cedex 1, France
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9
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Competing Risk Analysis in Lung Cancer Patients Over 80 Years Old Undergoing Surgery. World J Surg 2019; 43:1857-1866. [DOI: 10.1007/s00268-019-04982-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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10
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Tantraworasin A, Siwachat S, Tanatip N, Lertprasertsuke N, Kongkarnka S, Euathrongchit J, Wannasopha Y, Suksombooncharoen T, Chewaskulyong B, Taioli E, Saeteng S. Outcomes of pulmonary resection in non-small cell lung cancer patients older than 70 years old. Asian J Surg 2019; 43:154-165. [PMID: 30898491 DOI: 10.1016/j.asjsur.2019.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/23/2019] [Accepted: 03/05/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND An appropriate treatment of older lung cancer patients has become an important issue. The aim of this study is to evaluate the short and long-term surgical outcomes in lung cancer patients using 70 years as a cut-point, and to identify prognostic factors of cancer-specific mortality in patients older than 70 years. METHODS Medical records of non-small cell lung cancer (NSCLC) patients who underwent pulmonary resection at Chiang Mai University Hospital from January 2002 through December 2016 were retrospectively reviewed. Patients were divided into age less than 70 years (control group) and 70 years or more (study group). Primary outcomes were major post-operative complications and in-hospital death (POM); secondary outcome was long-term survival. Multivariable regression analysis was used. RESULTS This study included 583 patients, 167 for study group, and 416 for control group. There were no differences in POM, both at univariable and multivariable analyses, however, for long-term cancer-specific mortality, the study group was more likely to die (HRadj = 1.40, 95%CI = 1.03-1.89). Adverse prognostic factors for long-term mortality in study group were having universal coverage scheme (HRadj = 1.70, 95%CI = 1.03-2.79), the presence of intratumoral lymphatic invasion (HRadj = 2.83, 95%CI = 1.28-6.29), perineural invasion (HRadj = 2.80, 95%CI = 1.13-6.94), underwent lymph node sampling (HRadj = 2.23, 95%CI = 1.16-4.30) and higher stage of disease (HRadj = 2.02, 95%CI = 1.06-3.85 for stage III, HRadj = 3.40, 95%CI = 1.29-8.94 for stage IV). CONCLUSIONS In-hospital mortality and composite post-operative complications are acceptable in pulmonary resection for NSCLC patients older than 70 years. However, these patients had shorter long-term survival, especially who have some adverse prognostic factors. Further studies with larger sample size are warranted.
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Affiliation(s)
- Apichat Tantraworasin
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiang Mai University, Chiang Mai, Thailand; Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
| | - Sophon Siwachat
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Narumon Tanatip
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nirush Lertprasertsuke
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Sarawut Kongkarnka
- Department of Pathology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Juntima Euathrongchit
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Yutthaphan Wannasopha
- Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Busayamas Chewaskulyong
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Emanuela Taioli
- Tisch Cancer Institute, Institute for Translational Epidemiology, Department of Population Health Science and Policy, Icahn Medical School at Mount Sinai, New York, NY, USA
| | - Somcharoen Saeteng
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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11
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Hino H, Karasaki T, Yoshida Y, Fukami T, Sano A, Tanaka M, Furuhata Y, Ichinose J, Kawashima M, Nakajima J. Risk factors for postoperative complications and long-term survival in lung cancer patients older than 80 years. Eur J Cardiothorac Surg 2019; 53:980-986. [PMID: 29272371 DOI: 10.1093/ejcts/ezx437] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 11/13/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The number of octogenarian lung cancer patients undergoing radical surgery has been increasing recently. However, knowledge regarding the risk factors for postoperative complications and reliable predictive factors for long-term survival is limited. This study aimed to investigate the risk factors of postoperative complications, and reliable prognostic factors, in lung cancer patients older than 80 years. METHODS Lung cancer patients aged 80 years or older who underwent radical surgery were retrospectively studied; a multi-institutional analysis was conducted from January 1998 to December 2015. Preoperative and postoperative clinical data, including age, gender, smoking history, body mass index, respiratory function, Charlson Comorbidity Index, Glasgow Prognostic Score, surgical procedure, cancer histology, clinical and pathological stage, surgical result and survival time, were collected. RESULTS A total of 337 patients, comprising 216 (64.1%) men and 121 (35.9%) women were enrolled. The median age was 82 (range 80-92) years. Of the 337 patients, 205 (60.8%) had preoperative comorbidities. Postoperative complications were observed in 119 (35.3%) patients; postoperative mortalities occurred in 6 (1.8%) patients. Univariate and multivariate analyses showed that male gender (P = 0.01) and operation time (P = 0.047) were associated with postoperative complications; in contrast, pathological Stage III (P < 0.001), male gender (P = 0.01), Charlson Comorbidity Index ≥2 (P = 0.03) and Glasgow Prognostic Score = 1/2 (P = 0.04) were independent prognostic factors for overall survival. CONCLUSIONS The risk factors for postoperative complications (male gender and operation time) and the predictive factors affecting long-term survival (male gender, Charlson Comorbidity Index, Glasgow Prognostic Score and P-stage) should be taken into account for the effective management of patients older than 80 years with lung cancer, undergoing surgery.
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Affiliation(s)
- Haruaki Hino
- Department of Thoracic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Takahiro Karasaki
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Yukihiro Yoshida
- Department of Thoracic Surgery, Asahi General Hospital, Asahi, Japan
| | - Takeshi Fukami
- Department of Thoracic Surgery, National Hospital Organization Tokyo National Hospital, Kiyose, Japan
| | - Atsushi Sano
- Department of Thoracic Surgery, Chigasaki Municipal Hospital, Chigasaki, Japan
| | - Makoto Tanaka
- Department of Thoracic Surgery, JR Tokyo General Hospital, Tokyo, Japan
| | - Yoshiaki Furuhata
- Department of Thoracic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Junji Ichinose
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Mitsuaki Kawashima
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Jun Nakajima
- Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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12
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Hong S, Moon YK, Park JK. Comparison of Surgical Outcomes and Survival between Octogenarians and Younger Patients after Pulmonary Resection for Stage I Lung Cancer. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 51:312-321. [PMID: 30402390 PMCID: PMC6200170 DOI: 10.5090/kjtcs.2018.51.5.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 11/15/2017] [Accepted: 11/16/2017] [Indexed: 11/20/2022]
Abstract
Background Treatment strategies for octogenarians with lung cancer remain controversial. The purpose of this study was to compare surgical outcomes and survival between octogenarians and younger patients with stage IA and IB lung cancer. Methods We reviewed the medical records of 34 consecutive octogenarians and 457 younger patients (<70 years) with stage I lung cancer who underwent surgical resection from January 2007 to December 2015. We analyzed the survival and surgical outcomes of the 2 groups according to the lung cancer stage (IA and IB). Results The only significant differences in the clinicopathological features between the groups were the higher proportion of sublobar resection (56.3% vs. 18.9%) and the smaller number of dissected lymph nodes (LNs) in octogenarians. There was no significant difference in hospital stay (11 days vs. 9 days), pneumonia (5.8% vs 1.9%), or operative mortality (0% vs 0.6%) between the 2 groups. Among patients with stage IA lung cancer, 5-year recurrence-free survival was not significantly different between the octogenarians (n=16) and younger patients (n=318) (86.2% vs. 89.1%, p=0.548). However, 5-year overall survival was significantly lower in octogenarians than in younger patients (79.4% vs. 93.4%, p=0.009). Among patients with stage IB lung cancer, there was no significant difference in 5-year recurrence-free survival (62.1% vs. 73.5%, p=0.55) or overall survival (77.0% vs 85.0%, p=0.75) between octogenarians (n=18) and younger patients (n=139). In multivariable analysis, male sex, the number of dissected LNs, and tumor size were factors related to survival (hazard ratio [HR], 5.795; p=0.017; HR, 0.346, p=0.025; and HR, 1.699; p=0.035, respectively). Conclusion Surgical outcomes and survival after pulmonary resection for stage I lung cancer were comparable in octogenarians and younger patients. Continued careful selection of octogenarians for pulmonary resection is important to achieve good results.
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Affiliation(s)
- Seokbeom Hong
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Young Kyu Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
| | - Jae Kil Park
- Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea
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13
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Vazirani J, Moraes J, Barnett S, Johnson DF, Knight S, Miller A, Wright G, Alam NZ, Conron M, Irving LB, Antippa P, Steinfort DP. Outcomes following resection of non-small cell lung cancer in octogenarians. ANZ J Surg 2018; 88:1322-1327. [DOI: 10.1111/ans.14861] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 08/04/2018] [Accepted: 08/06/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Jaideep Vazirani
- Department of Respiratory and Sleep Medicine; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Johanna Moraes
- Department of Respiratory and Sleep Medicine; The Royal Melbourne Hospital; Melbourne Victoria Australia
| | - Stephen Barnett
- Department of Cardiothoracic Surgery; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Department of Thoracic Surgery; Austin Hospital; Melbourne Victoria Australia
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
- Department of Surgery; The University of Melbourne; Melbourne Victoria Australia
| | - Douglas F. Johnson
- Department of Medicine; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Department of Medicine; University of Melbourne; Melbourne Victoria Australia
| | - Simon Knight
- Department of Thoracic Surgery; Austin Hospital; Melbourne Victoria Australia
- Department of Surgery; The University of Melbourne; Melbourne Victoria Australia
| | - Alistair Miller
- Department of Respiratory and Sleep Medicine; Monash Health; Melbourne Victoria Australia
| | - Gavin Wright
- Department of Cardiothoracic Surgery; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
- Department of Surgery; The University of Melbourne; Melbourne Victoria Australia
- Department of Cardiothoracic Surgery; St Vincent's Hospital; Melbourne Victoria Australia
| | - Naveed Z. Alam
- Department of Surgery; The University of Melbourne; Melbourne Victoria Australia
- Department of Cardiothoracic Surgery; St Vincent's Hospital; Melbourne Victoria Australia
| | - Matthew Conron
- Department of Respiratory and Sleep Medicine; St Vincent's Hospital; Melbourne Victoria Australia
- Department of Cancer Medicine; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Louis B. Irving
- Department of Respiratory and Sleep Medicine; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Department of Medicine; University of Melbourne; Melbourne Victoria Australia
- Department of Cancer Medicine; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
| | - Phillip Antippa
- Department of Cardiothoracic Surgery; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Division of Cancer Surgery; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
- Department of Surgery; The University of Melbourne; Melbourne Victoria Australia
| | - Daniel P. Steinfort
- Department of Respiratory and Sleep Medicine; The Royal Melbourne Hospital; Melbourne Victoria Australia
- Department of Medicine; University of Melbourne; Melbourne Victoria Australia
- Department of Cancer Medicine; Peter MacCallum Cancer Centre; Melbourne Victoria Australia
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14
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Laisaar T, Sarana B, Benno I, Laisaar KT. Surgically treated lung cancer patients: do they all smoke and would they all have been detected with lung cancer screening? ERJ Open Res 2018; 4:00001-2018. [PMID: 30083553 PMCID: PMC6073050 DOI: 10.1183/23120541.00001-2018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 06/28/2018] [Indexed: 12/18/2022] Open
Abstract
Since publication of the National Lung Cancer Screening Trial (NLST) results early lung cancer detection has been widely studied, targeting individuals based on smoking history and age. However, over recent decades several changes in lung cancer epidemiology, including risk factors, have taken place. The aim of the current study was to explore smoking prevalence among lung cancer patients who had been treated surgically or undergone a diagnostic operation and whether these patients would have met the NLST inclusion criteria. All patients operated on for lung cancer in a university hospital in Estonia between 2009 and 2015 were included. Data were collected from hospital records. 426 patients were operated on for lung cancer, with smoking history properly documented in 327 patients (87 females; median age 67 years). 170 (52%) patients were smokers, 97 (30%) patients were ex-smokers and 60 (18%) patients were nonsmokers. The proportion of females among smokers was 15%, among ex-smokers was 9% and among nonsmokers was 87%. 107 of our patients would not have met the NLST age criteria and 128 of our patients would not have met the NLST smoking criteria. In total, 183 patients (56% (79% of females and 48% of males)) would not have met the NLST inclusion criteria. Only half of surgically treated lung cancer patients were current smokers and more than half did not meet the NLST inclusion criteria. Many currently surgically treated lung cancer patients, especially females, are not a target for lung cancer screeninghttp://ow.ly/L9wY30kIQW0
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Affiliation(s)
- Tanel Laisaar
- Dept of Thoracic Surgery, Lung Clinic, Tartu University Hospital, Tartu, Estonia.,Lung Clinic, Tartu University, Tartu, Estonia
| | - Bruno Sarana
- Dept of Thoracic Surgery, Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Indrek Benno
- Dept of Thoracic Surgery, Lung Clinic, Tartu University Hospital, Tartu, Estonia
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15
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Long-term results of surgical treatment of non-small cell lung cancer in patients over 75 years of age. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 15:65-71. [PMID: 30069185 PMCID: PMC6066686 DOI: 10.5114/kitp.2018.76470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 02/12/2018] [Indexed: 11/17/2022]
Abstract
Introduction Patients over 75 years of age, who, in addition, often have already exceeded the average life expectancy, in the Polish population on average 77.4 years, are the subject of discussion concerning the most appropriate choice of treatment. Aim To analyse the long-term results in elderly patients over 75 years of age with lung cancer who underwent curative pulmonary resection. Material and methods 166 patients aged from 75 to 85 (mean: 77.4 ±2.3) operated on for non-small cell lung cancer (NSCLC) were included in this study. There were 128 (77%) men and 38 (23%) women. Results Lobectomy, including bilobectomy, was performed in 122 (74%) patients, pneumonectomy in 8 (5%) patients, and wedge resections or segmentectomy in the remaining 36 patients. Squamous or adenocarcinoma was diagnosed in 46% and 42% of cases respectively. Clinical stage I A was diagnosed in 36 (22%) patients, I B in 51 (31%), IIA in 30 (18%), IIB in 19 (11%) and IIIA in 30 (18%) of our cases. The early 30-day postoperative mortality was 5% whilst postoperative morbidity occurred in 47% of cases. The five-year survival rate was 30%. In statistical analysis, the TNM classification (p = 0.0490), the number of postoperative complications (p = 0.0001) and obstructive atelectasis requiring repeat bronchofibroscopic aspirations (p = 0.0137) in the early postoperative period most negatively influenced the long-term survival in the whole study group. Conclusions Surgical resections for lung cancer in patients over 75 years of age are characterised by a relatively good long-term prognosis. Careful and strictly detailed preoperative selection, particularly of patients with pulmonary comorbidities and the earliest possible diagnosis of a lung tumour, can reduce the occurrence of these postoperative complications in elderly patients, which negatively influence long-term results.
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16
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Comorbidity Profiles and Their Effect on Treatment Selection and Survival among Patients with Lung Cancer. Ann Am Thorac Soc 2018; 14:1571-1580. [PMID: 28541748 DOI: 10.1513/annalsats.201701-030oc] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Prior work has shown that the comorbidity burden is high among patients with lung cancer, but patterns of comorbid conditions have not been systematically identified. OBJECTIVES We aimed to identify distinct comorbidity profiles in a large sample of patients with lung cancer and to examine the effect of comorbidity profiles on treatment and survival. METHODS In this retrospective cohort study, we used latent class analysis to identify comorbidity profiles (or classes) in a population-based sample of 6,662 patients with bronchogenic carcinoma diagnosed between 2008 and 2013. We included specific comorbid conditions from the Charlson comorbidity index. We used Cox proportional hazards analysis to examine the effect of comorbidity class on survival. RESULTS The mean age of the patients was 70 years, and 50% were female, 34% were nonwhite, and 17% were never-smokers. Most patients had stage III (21%) or IV (53%) disease. Over half (51%) had at least one comorbid condition, whereas 18% had at least four comorbidities. Latent class analysis identified five distinct comorbidity classes. Classes were defined by progressively greater Charlson comorbidity index scores and were further distinguished by the presence or absence of specific types of vascular disease and diabetes. Comorbidity class was independently associated with treatment selection (P < 0.001) and survival (P < 0.0001), especially among patients with stages 0-II disease (P < 0.0001). CONCLUSIONS Patients with lung cancer can be described by distinct comorbidity profiles that are independent predictors of treatment and survival. These profiles provide a more nuanced understanding of how comorbidities cluster within patients with lung cancer and how they can be applied for descriptive purposes or in research.
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17
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Yano T, Shimokawa M, Kawashima O, Takenoyama M, Yamashita Y, Fukami T, Ueno T, Yatsuyanagi E, Fukuyama S. The influence of comorbidity on the postoperative survival in elderly (≥ 75 years old) with lung cancer. Gen Thorac Cardiovasc Surg 2018; 66:344-350. [DOI: 10.1007/s11748-018-0919-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 03/31/2018] [Indexed: 11/29/2022]
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18
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Significance of Body Mass Index for Postoperative Outcomes after Lung Cancer Surgery in Elderly Patients. World J Surg 2017; 42:153-160. [DOI: 10.1007/s00268-017-4142-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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19
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Yano T, Kawashima O, Takeo S, Adachi H, Tagawa T, Fukuyama S, Shimokawa M. A Prospective Observational Study of Pulmonary Resection for Non-small Cell Lung Cancer in Patients Older Than 75 Years. Semin Thorac Cardiovasc Surg 2017; 29:540-547. [PMID: 29698655 DOI: 10.1053/j.semtcvs.2017.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2017] [Indexed: 11/11/2022]
Abstract
The operative morbidity rate in elderly patients with lung cancer is high in comparison to nonelderly patients, probably because of the increase in comorbidities that occurs with aging. However, previous reports were retrospective and were performed at single institutions; thus, the preoperative comorbidities and operative morbidity could not be fully assessed. We conducted a multi-institutional prospective observational study of elderly patients (>75 years of age) with a completely resected non-small cell lung cancer. From March 2014 to April 2015, 264 patients from 22 hospitals affiliated with the National Hospital Organization in Japan were prospectively registered in the present study. The primary end point was operative morbidity (National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0). The secondary end points were operative mortality and the risk factors for operative morbidity. Preoperative comorbidities were assessed according to the Adult Comorbidity Evaluation-27 index. The mean age at the time of surgery was 79.3 years (range 75-90 years). Forty-one percent of the patients were >80 years of age. Twenty-six percent underwent sublobar resection. The incidence of morbidities of any grade was 43.2% (90% confidence interval: 38.2%-48.2%). Respiratory system-related morbidity (19.3%), followed by cardiovascular system-related morbidity (10.2%), was the most common morbidity. The in-hospital mortality rate was 1.1% (3 of 264 patients). A multivariate analysis of the risk factors for operative morbidity showed that both Adult Comorbidity Evaluation-27 grade and the blood loss volume were significant factors. The results of the present prospective multi-institutional study should be used as a reference in the surgical treatment of elderly patients with lung cancer.
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Affiliation(s)
- Tokujiro Yano
- Department of General Thoracic Surgery, National Hospital Organization Beppu Medical Center, Beppu, Japan.
| | - Osamu Kawashima
- Department of Chest Surgery, National Hospital Organization Shibukawa Medical Center, Shibukawa, Japan
| | - Sadanori Takeo
- Department of Thoracic Surgery, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Hirofumi Adachi
- Department of Thoracic Surgery, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Tsutomu Tagawa
- Department of Thoracic Surgery, National Hospital Organization Nagasaki Medical Center, Omura, Japan
| | - Seiichi Fukuyama
- Department of General Thoracic Surgery, National Hospital Organization Beppu Medical Center, Beppu, Japan
| | - Mototsugu Shimokawa
- Cancer Biostatistics Laboratory, Clinical Research Institute, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
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20
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Tutic-Horn M, Gambazzi F, Rocco G, Mosimann M, Schneiter D, Opitz I, Martucci N, Hillinger S, Weder W, Jungraithmayr W. Curative resection for lung cancer in octogenarians is justified. J Thorac Dis 2017; 9:296-302. [PMID: 28275477 DOI: 10.21037/jtd.2017.02.22] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Due to an increased life expectancy in a healthy aging population and a progressive incidence of lung cancer, curative pulmonary resections can be performed even in octogenarians. The present study aims to investigate whether surgery is justified in patients reaching the age of 80 years and older who undergo resection for non-small cell lung cancer (NSCLC). METHODS In this retrospective multi-centre analysis, the morbidity, mortality and long-term survival of 88 patients (24 females) aged ≥80 who underwent complete resection for lung cancer between 2000 and 2013 were analysed. Only fit patients with few comorbidities, low cardiopulmonary risk, good quality of life and a life expectancy of at least 5 years were included. RESULTS Curative resections from three thoracic surgery centres included 61 lobectomies, 9 bilobectomies, 6 pneumonectomies and 12 segmentectomies or wide wedge resections with additional systematic mediastinal lymphadenectomy in all cases. Final histology revealed squamous cell carcinoma [33], adenocarcinoma [41], large cell carcinoma [5] or other histological types [9]. Lung cancer stage distribution was 0 [1], I [53], II [17] and IIIA [14]. The overall 90-day mortality was 1.1%. The median hospitalisation and chest drainage times were 10 days (range, 5-27 days) and 5 days (range, 0-17 days), respectively. Thirty-six patients were complication-free (41%). In particular, pulmonary complications occurred in 25 patients (28%). In addition, 23 patients (26%) developed cardiovascular complications requiring medical intervention, while 24 patients (27%) had cerebrovascular complications, urinary tract infection and others. The median survival time was 51 months (range, 1-110 months), and the 5-year overall survival reached 45% without significance between tumour stages. CONCLUSIONS Curative lung resections in selected octogenarians can be safely performed up to pneumonectomy for all tumour stages with a perioperative mortality, morbidity, and 5-year survival rate comparable to younger cohorts.
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Affiliation(s)
- Michaela Tutic-Horn
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Franco Gambazzi
- Division of Thoracic Surgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Gaetano Rocco
- Division of Thoracic Surgery, University Hospital Naples, Naples, Italy
| | - Monique Mosimann
- Division of Thoracic Surgery, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Didier Schneiter
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Nono Martucci
- Division of Thoracic Surgery, University Hospital Naples, Naples, Italy
| | - Sven Hillinger
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Walter Weder
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Wolfgang Jungraithmayr
- Department of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland;; Department of Thoracic Surgery, Medical University Brandenburg, Germany
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21
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Hino H, Nishimura T, Usuki C, Sazuka M, Ito T, Seki A, Nitadori JI, Yamada H, Arai T, Yamamoto H, Nakajima J. Salvage surgery for primary lung cancer after chemotherapy in octogenarians. Thorac Cancer 2017; 8:271-274. [PMID: 28239985 PMCID: PMC5415469 DOI: 10.1111/1759-7714.12423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 12/29/2016] [Accepted: 01/07/2017] [Indexed: 11/28/2022] Open
Abstract
An 81‐year‐old female patient was admitted to our institute because of abnormal X‐ray results. Chest computed tomography showed a 7.7 × 5.3 cm mass located in the left lower lobe and multiple swollen lymph nodes. 18F‐fluorodeoxyglucose‐positron emission tomography indicated high standard uptake values in the mass and swollen lymph nodes. The patient was diagnosed with stage cT3N2M0‐IIIA squamous cell carcinoma. Although the patient had multiple lymph node metastases and severe obstructive pulmonary function, four cycles of platinum doublet chemotherapy were initially performed and no side effect greater than grade 3 was experienced. As the lung cancer was downstaged to ycT2aN0M0‐IB and pulmonary function had improved, a bronchodilating preparation, an uneventful left lower lobectomy, and a lymphadenectomy were performed. The patient was discharged 39 days after surgery and exhibited good health for a year at pathological stage ypT1aN0M0‐IA (Ef2).
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Affiliation(s)
- Haruaki Hino
- Department of Thoracic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Takashi Nishimura
- Department of Thoracic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Chiemi Usuki
- Department of Respiratory Medicine, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Manami Sazuka
- Department of Respiratory Medicine, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Takuya Ito
- Department of Thoracic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Atsuko Seki
- Department of Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Jun-Ichi Nitadori
- Department of Thoracic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan.,Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hirokazu Yamada
- Department of Respiratory Medicine, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Tomio Arai
- Department of Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Hiroshi Yamamoto
- Department of Pathology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Jun Nakajima
- Department of Thoracic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan.,Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
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Abstract
Lung cancer is the leading cause of cancer-associated mortality in the USA. The median age at diagnosis of lung cancer is 70 years, and thus, about one-half of patients with lung cancer fall into the elderly subgroup. There is dearth of high level of evidence regarding the management of lung cancer in the elderly in the three broad stages of the disease including early-stage, locally advanced, and metastatic disease. A major reason for the lack of evidence is the underrepresentation of elderly in prospective randomized clinical trials. Due to the typical decline in physical and physiologic function associated with aging, most elderly do not meet the stringent eligibility criteria set forth in age-unselected clinical trials. In addition to performance status, ideally, comorbidity, cognitive, and psychological function, polypharmacy, social support, and patient preferences should be taken into account before applying prevailing treatment paradigms often derived in younger, healthier patients to the care of the elderly patient with lung cancer. The purpose of this chapter was to review the existing evidence of management of early-stage, locally advanced disease, and metastatic lung cancer in the elderly.
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Affiliation(s)
- Archana Rao
- Department of Medicine, Upstate Medical University, 750 E Adams Street, Syracuse, NY, 13210, USA
| | - Namita Sharma
- Department of Medicine, Upstate Medical University, 750 E Adams Street, Syracuse, NY, 13210, USA
| | - Ajeet Gajra
- Department of Medicine, Upstate Medical University, 750 E Adams Street, Syracuse, NY, 13210, USA.
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Sacco PC, Casaluce F, Sgambato A, Rossi A, Maione P, Palazzolo G, Napolitano A, Gridelli C. Current challenges of lung cancer care in an aging population. Expert Rev Anticancer Ther 2015; 15:1419-1429. [DOI: 10.1586/14737140.2015.1096201] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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24
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Risk factor for respiratory death after lung cancer surgery in octogenarians. Asian Cardiovasc Thorac Ann 2015; 23:1044-9. [DOI: 10.1177/0218492315605725] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background As society ages, the frequency of elderly patients undergoing surgery for lung cancer is increasing. However, the indications for surgery in octogenarians are still controversial. We examined the outcomes of elderly patients undergoing thoracic surgery for lung cancer, focusing especially on non-cancer-related death. Methods Between January 2004 and March 2011, 1673 patients with lung cancer underwent surgical resection at our institution. Of these, we retrospectively examined 174 patients aged 80 years or older. Results Perioperative morbidity and mortality were 24.3% and 1.15%, respectively. Of 163 patients who were followed up completely, 78 (47.9%) died. The overall postoperative survival rate at 3 and 5 years was 63.6% and 48.3%, respectively. Almost half of the deaths were due to causes other than lung cancer recurrence, with respiratory disease accounting for the majority. We found that a low body mass index was a significant risk factor for death due to respiratory disease after lung cancer surgery in this patient cohort. Conclusion The overall survival rate of octogenarians undergoing lung cancer surgery is acceptable. However, because octogenarians with a low body mass index have a significantly higher risk of death due to respiratory disease, surgeons and pulmonologists should take this into account when performing postoperative follow-up in these patients.
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Leduc C, Quoix E. Systemic treatment of elderly patients. Lung Cancer 2015. [DOI: 10.1183/2312508x.10010614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Freixinet Gilart J, Rodríguez Suárez PM. Morbidity, mortality and survival after surgery for lung cancer. Arch Bronconeumol 2015; 51:211-2. [PMID: 25857573 DOI: 10.1016/j.arbres.2015.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 01/28/2015] [Accepted: 02/10/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Jorge Freixinet Gilart
- Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Isla de Gran Canaria, España.
| | - Pedro Miguel Rodríguez Suárez
- Hospital Universitario de Gran Canaria Dr. Negrín, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Isla de Gran Canaria, España
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Hino H, Murakawa T, Ichinose J, Nagayama K, Nitadori J, Anraku M, Nakajima J. Results of Lung Cancer Surgery for Octogenarians. Ann Thorac Cardiovasc Surg 2015; 21:209-16. [PMID: 25740447 DOI: 10.5761/atcs.oa.14-00160] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Growing number of elderly lung cancer patients reflecting a lengthening life span has become a serious problem. Purpose of this study was to elucidate the short and long-term outcome of the surgery for octogenarians, and to evaluate the role of lung cancer surgery for this high age group. METHODS The patients with lung cancer aged 80 years or more who underwent the surgery at our institute from January 1998 through December 2012 were retrospectively analyzed by chart review, and the operative mortality, morbidity and the long-term survival were assessed. RESULTS Out of a total of 1107 patients with primary lung cancer who received surgery during the study period, 94 were octogenarians (8.5%). Sixty-nine patients (73.4%) had preoperative co-morbidity including hypertension in 50 (53.2%), coincidence of other malignancy in 35 (37.2%), anti-coagulant therapy in 29 (30.9%). Twenty-six patients (27.7%) had major or minor postoperative morbidity, and one (1.1%) died due to bronchopleural fistula. Overall-5-year survival rate was 57.5%. Univariative and multivariative analysis using Cox proportional hazard model revealed that male gender and non-adenocarcinoma histology were significant risk factors for poor prognosis. CONCLUSION Gender and histology should be taken into account in preoperative evaluation of indication for lung cancer in octogenarians.
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Affiliation(s)
- Haruaki Hino
- Department of Thoracic Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Froesch P, Martucci F, Györik S, Dutly AE, Cafarotti S. Management of non-small cell lung cancer in the elderly. Eur J Intern Med 2014; 25:888-94. [PMID: 25468247 DOI: 10.1016/j.ejim.2014.10.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 10/16/2014] [Accepted: 10/28/2014] [Indexed: 12/27/2022]
Abstract
Most developed countries accepted the chronological age of 70 years as the definition of "elderly" and there is a general consensus in clinical practice to consider this age as the threshold in risk assessment. This has a strong impact in the choice of treatment of these lung cancer patients. Indeed, more than 50% of these patients are over 70 and nearly 30% are over 75 years old. Because of the increasing number of elderly patients that are generally fitter than in the past, the treatment options should rather be based on individual fitness, taking into account risks and benefits of the diagnostic and therapeutic procedures. This means considering biological rather than chronological age to make decisions. For these reasons, we developed a simplified short comprehensive geriatric assessment (sCGA), including a standardised evaluation of activity of daily living, depression, cognitive status, comorbidities and geriatric syndromes. This allowed us the classification of these patients into 3 categories: frail, vulnerable and fit. Through the emblematic case of a fit elderly man affected by NSLCC, we present the multidisciplinary assessment and discussions to identify the best treatment options for this patient.
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Affiliation(s)
- Patrizia Froesch
- Department of Medical Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
| | - Francesco Martucci
- Department of Radiotherapy, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Sandor Györik
- Department of Internal Medicine and Pulmonology, ORBV, Bellinzona, Switzerland
| | - André Emanuel Dutly
- Referral center for Thoracic Surgery in Ticino, ORBV, Bellinzona, Switzerland
| | - Stefano Cafarotti
- Referral center for Thoracic Surgery in Ticino, ORBV, Bellinzona, Switzerland
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Dell’Amore A, Monteverde M, Martucci N, Sanna S, Caroli G, Dolci G, Dell’Amore D, Rocco G. Lobar and sub-lobar lung resection in octogenarians with early stage non-small cell lung cancer: factors affecting surgical outcomes and long-term results. Gen Thorac Cardiovasc Surg 2014; 63:222-30. [DOI: 10.1007/s11748-014-0493-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 10/28/2014] [Indexed: 11/29/2022]
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Lung Cancer in Older Adults. CURRENT GERIATRICS REPORTS 2014. [DOI: 10.1007/s13670-014-0092-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Pallis AG, Gridelli C, Wedding U, Faivre-Finn C, Veronesi G, Jaklitsch M, Luciani A, O'Brien M. Management of elderly patients with NSCLC; updated expert's opinion paper: EORTC Elderly Task Force, Lung Cancer Group and International Society for Geriatric Oncology. Ann Oncol 2014; 25:1270-1283. [PMID: 24638905 DOI: 10.1093/annonc/mdu022] [Citation(s) in RCA: 109] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
Non-small-cell lung cancer (NSCLC) is a very common disease in the elderly population and its incidence in this particular population is expected to increase further, because of the ageing of the Western population. Despite this, limited data are available for the treatment of these patients and, therefore, the development of evidence-based treatment recommendations is challenging. In 2010, European Organization for Research and Treatment of Cancer (EORTC) took an initiative in collaboration with International Society of Geriatric Oncology (SIOG) and created an experts panel that provided an experts' opinion consensus paper for the management of elderly NSCLC patients. Since this publication, important new data are available and EORTC and SIOG recommended to update the 2010 recommendations. Besides recommendations for surgery, adjuvant chemotherapy and radiotherapy, treatment of locally advanced and metastatic disease, recommendations were expanded, to include data on patient preferences and geriatric assessment.
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Affiliation(s)
- A G Pallis
- Medical Department, European Organization for Research and Treatment of Cancer, Brussels, Belgium.
| | - C Gridelli
- Division of Medical Oncology, 'S.G. Moscati' Hospital-Avellino, Avellino, Italy
| | - U Wedding
- Department of Internal Medicine II, Jena University Hospital, Jena, Germany
| | | | - G Veronesi
- Lung Cancer Early Detection Unit, Division of Thoracic Surgery, European Institute of Oncology, Milano, Italy
| | - M Jaklitsch
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | - A Luciani
- Department of Medical Oncology, S. Paolo Hospital, Milan, Italy
| | - M O'Brien
- The Royal Marsden NHS Foundation, Surrey, UK
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Mediratta N, Shackcloth M, Page R, Woolley S, Asante-Siaw J, Poullis M. Should males ever undergo wedge resection for stage 1 non-small-cell lung cancer? A propensity analysis†. Eur J Cardiothorac Surg 2014; 46:267-73; discussion 273. [DOI: 10.1093/ejcts/ezt603] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Warwick R, Mediratta N, Shackcloth M, Page R, McShane J, Shaw M, Poullis M. Wedge resection verses lobectomy for stage 1 non-small-cell lung cancer. Asian Cardiovasc Thorac Ann 2013; 21:566-73. [DOI: 10.1177/0218492312466861] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Lobectomy remains the gold standard with regard to potentially curative resection of non-small-cell lung carcinoma. We aimed to investigate whether there is a survival difference in stage 1 non-small-cell lung cancer patients who undergo lobectomy compared to a wedge resection. Methods We retrospectively analyzed a prospective database of 1283 patients who had potentially curative resection for stage 1 non-small-cell lung cancer. Only patients with adenocarcinoma, squamous or adenosquamous carcinoma were included. We benchmarked our 5-year survival against the 6th International Association for the Study of Lung Cancer results. Three techniques were used to assess the effect of a lobectomy compared to a wedge resection with regard to long-term survival: Cox multivariate regression analysis, neuronal network analysis, and propensity matching. Results Benchmarking failed to reveal any significant difference compared to the 6th International Association for the Study of Lung Cancer results. Crude analysis demonstrated superiority of lobectomy compared to wedge resection, p = 0.02. Cox regression analysis confirmed that age, body mass index, female sex, being a current smoker, tumor diameter, and preoperative forced expiratory volume in 1 s were all significant factors determining long-term survival. Wedge resection was not a significant factor. Neuronal network analysis concurred with the Cox regression analysis. Propensity matching with 1:1 matching demonstrated that wedge resections was not inferior to a lobectomy, p = 0.10. Conclusions Cox regression analysis, neuronal network analysis, and propensity matching in stage 1 non-small-cell lung cancer demonstrate no difference in long-term survival after wedge resection compared to lobectomy.
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Affiliation(s)
| | | | | | - Richard Page
- Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | - Matthew Shaw
- Liverpool Heart and Chest Hospital, Liverpool, UK
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Brunelli A, Kim AW, Berger KI, Addrizzo-Harris DJ. Physiologic Evaluation of the Patient With Lung Cancer Being Considered for Resectional Surgery. Chest 2013; 143:e166S-e190S. [DOI: 10.1378/chest.12-2395] [Citation(s) in RCA: 542] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Guerra M, Neves P, Miranda J. Surgical treatment of non-small-cell lung cancer in octogenarians. Interact Cardiovasc Thorac Surg 2013; 16:673-80. [PMID: 23396622 DOI: 10.1093/icvts/ivt020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Reluctance to recommend lung cancer surgery for octogenarians is partly based on the expectation that the rate of complications and mortality is higher in this group of patients, and on the impression that the life expectancy of an octogenarian with lung cancer is limited by death from natural causes. Moreover, the belief that radiation therapy and observation yield similar results to surgery in early-stage disease have influenced low resection rates in this population. Nevertheless, advances in surgical techniques, anaesthesia and postoperative care have made surgical lung resection a safer procedure than it was in the past. Judging from the more recent findings, surgery should not be withheld because of postoperative mortality, but suboptimal or palliative treatment may be necessary in patients with poor physical or mental function. To enable informed decision-making, both patients and clinicians need information on the risks of surgical treatment. In this review, available information from the literature was collected in an effort to understand the real benefit of surgical treatment in octogenarians with non-small-cell lung cancer, and to determine what should be done or avoided during the selection course.
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Affiliation(s)
- Miguel Guerra
- Department of Cardiothoracic Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nove de Gaia, Portugal.
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Dell'Amore A, Monteverde M, Martucci N, Sanna S, Caroli G, Stella F, Dell'Amore D, Rocco G. Early and long-term results of pulmonary resection for non-small-cell lung cancer in patients over 75 years of age: a multi-institutional study. Interact Cardiovasc Thorac Surg 2012. [PMID: 23178392 DOI: 10.1093/icvts/ivs473] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Older lung cancer patients with multiple morbidities are increasingly referred to thoracic surgery departments. The aim of this multicenter study was to analyse the prognostic factors for in-hospital morbidity and mortality and to elucidate the predictors of long-term survival and oncological outcomes. METHODS We identified 319 patients aged ≥ 75 years who underwent intended curative lung resection for lung cancer in three different thoracic surgery departments between January 2000 and December 2010. RESULTS Seventy-one patients underwent limited resection, 202 had lobectomy, 16 had bilobectomy and 30 had pneumonectomy. The in-hospital mortality was 6.6%. Chronic renal failure, low respiratory reserve and pneumonectomy were predictors of in-hospital mortality. The mean follow-up time was 3.9 years, ranging from 1 month to 10.4 years. The disease-free survivals at 1, 3 and 5 years were 82, 60 and 47%, respectively. The overall survivals at 1, 3 and 5 years were 86, 59 and 38%, respectively. The long-term overall survival was negatively influenced by pneumonectomy, extended resection, N(1-2) subgroups and pathological TNM stage. CONCLUSIONS Nowadays, we can consider surgery a safe and justifiable option for elderly patients. Careful preoperative work-up and selection are mandatory to gain satisfactory results. Good long-term results were achieved in elderly patients with early stage who underwent lobar or sublobar lung resection. The role of surgery or other alternative therapies, in patients with advanced stages, extensive nodal involvement and/or requiring extensive surgical resection for curative intent, is still unclear and further studies are certainly needed.
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Affiliation(s)
- Andrea Dell'Amore
- Thoracic Surgery Operative Unit, S. Orsola Malpighi University Hospital, University of Bologna, Bologna, Italy
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Wang S, Wong ML, Hamilton N, Davoren JB, Jahan TM, Walter LC. Impact of age and comorbidity on non-small-cell lung cancer treatment in older veterans. J Clin Oncol 2012; 30:1447-55. [PMID: 22454424 DOI: 10.1200/jco.2011.39.5269] [Citation(s) in RCA: 126] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Because comorbidity affects cancer treatment outcomes, guidelines recommend considering comorbidity when making treatment decisions in older patients with lung cancer. Yet, it is unclear whether treatment is targeted to healthier older adults who might reasonably benefit. PATIENTS AND METHODS Receipt of first-line guideline-recommended treatment was assessed for 20,511 veterans age ≥ 65 years with non-small-cell lung cancer (NSCLC) in the Veterans Affairs (VA) Central Cancer Registry from 2003 to 2008. Patients were stratified by age (65 to 74, 75 to 84, ≥ 85 years), Charlson comorbidity index score (0, 1 to 3, ≥ 4), and American Joint Committee on Cancer stage (I to II, IIIA to IIIB, IIIB with malignant effusion to IV). Comorbidity and patient characteristics were obtained from VA claims and registry data. Multivariate analysis identified predictors of receipt of guideline-recommended treatment. RESULTS In all, 51% of patients with local, 35% with regional, and 27% with metastatic disease received guideline-recommended treatment. Treatment rates decreased more with advancing age than with worsening comorbidity for all stages, such that older patients with no comorbidity had lower rates than younger patients with severe comorbidity. For example, 50% of patients with local disease age 75 to 84 years with no comorbidity received surgery compared with 57% of patients age 65 to 74 years with severe comorbidity (P < .001). In multivariate analysis, age and histology remained strong negative predictors of treatment for all stages, whereas comorbidity and nonclinical factors had a minor effect. CONCLUSION Advancing age is a much stronger negative predictor of treatment receipt among older veterans with NSCLC than comorbidity. Individualized decisions that go beyond age and include comorbidity are needed to better target NSCLC treatments to older patients who may reasonably benefit.
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Affiliation(s)
- Sunny Wang
- San Francisco Veterans Affairs Medical Center, San Francisco, CA 94121, USA.
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The elderly patient with surgically resected non-small cell lung cancer — A distinct situation? Exp Gerontol 2012; 47:237-42. [DOI: 10.1016/j.exger.2011.12.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 12/05/2011] [Accepted: 12/18/2011] [Indexed: 11/30/2022]
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Amer K, Khan AZ, Vohra H, Saad R. Is it safe to include octogenarians at the start of a video-assisted thoracic surgery lobectomy programme? Eur J Cardiothorac Surg 2011; 41:346-52. [PMID: 21900023 DOI: 10.1016/j.ejcts.2011.05.038] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
OBJECTIVE The study aimed to investigate the safety of including patients ≥ 80 years of age at the start of a video-assisted thoracic surgery major pulmonary resection (VMPR) programme. METHODS Patients were considered for VMPR if the computed tomography/positron emission tomography (CT/PET) was suggestive of T1-3, N0-1 and M0 lesion. Age was not a criterion for exclusion at the very start of the programme. Data were collected prospectively and comparison made between two groups, (A) <80 years of age and (B) ≥ 80 years, in terms of preoperative risk factors, oncological and functional data, operative results, postoperative complications and survival. RESULTS Between April 2005 and January 2011, 200 consecutive patients were considered for VMPR. A total of 160 had non-small-cell lung cancer, of whom 136 were in group A, with a median age of 66.5 (range: 42.8-79.4 years) and 24 in group B with a median age of 82 (range: 80-85.5 years). In group B, 13 were men and 11 were women. Rate of conversion to thoracotomy was similar (3 (12.5%) in group B vs 17 (12.5%) in group A, p = 0.65), and so was the mean hospital stay (5.8 ± 3.3 days in group B vs 5.9 ± 4.6 days in group A, p = 0.899). Admission to intensive care unit and atrial fibrillation were significantly higher in octogenarians (six (25%) and six (25%) in group B vs eight (5.9%) and nine (6.6%) in group A, p = 0.008 and p = 0.012, respectively). There was significantly less mean days of air leak in octogenarians (0.06 ± 0.3 days in group B vs 2.8 ± 5.6 days in group A, p = 0.000). Otherwise, there were no age-related differences in relation to morbidity, mortality and the 3-year survival rate. CONCLUSION Octogenarians undergoing VMPR have a higher incidence of atrial fibrillation and admission to the intensive care unit for cardiopulmonary support but otherwise are no different from younger age groups when it comes to rate of conversion to thoracotomy, hospital stay, morbidity and mortality. Age should not be an excuse to deny the elderly curative VATS resection. In our experience, accepting octogenarians early in the VMPR programme did not compromise the outcome results.
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Affiliation(s)
- Khalid Amer
- The Cardiovascular & Thoracic Unit, Southampton General Hospital, Southampton, UK.
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