Surgical treatment of non-small-cell lung cancer in octogenarians: a single-centre retrospective study

Effect of Perioperative Factors on Short-Term Outcomes in Patients with Non-Small Cell Lung Cancer Over 60 Years of Age

Background

People in China have gradually entered old age society, and the number of lung cancer cases is expected to increase annually among the elderly. This study aimed to retrospectively explore the association between perioperative factors and short-term outcomes in elderly patients with non-small cell lung cancer (NSCLC).

Methods

A total of 490 elderly patients with NSCLC between January 1, 2003, and December 31, 2009, were selected. Perioperative factors were grouped and analyzed according to postoperative complications (PPCs) and length of hospital stay. A logistic regression analysis model was used to screen for the independent predictors of patient prognosis. The primary endpoint was postoperative complications and the secondary endpoint was postoperative hospital stay.

Results

Of all patients, 344 (70.2%) developed postoperative complications, and the average length of stay after surgery was 14.0±5.6 days. Perioperative fentanyl equivalents>28.7μg/kg and duration of surgery>4.4h were associated were associated with an increased risk of postoperative complications (P < 0.05); intraoperative blood loss (IBL) > 200 mL was associated with extended hospital stay (P < 0.05).

Conclusion

This study suggested that Perioperative factors may affect the short-term prognosis of elderly NSCLC patients after surgery. Perioperative fentanyl equivalents>28.7μg/kg, surgery duration, and IBL may be independent predictors of short-term outcomes in elderly patients.

Identifying octogenarians with non-small cell lung cancer who could benefit from surgery: A population-based predictive model

Background

As the population ages, there will be an increasing number of octogenarian patients with non-small cell lung cancer (NSCLC). In carefully selected elderly patients, surgery can improve long-term survival. To identify candidates who would benefit from surgery, we performed this study and built a predictive model.

Materials and methods

Data from NSCLC patients over 80 years old were obtained from the Surveillance, Epidemiology and End Results database. A 1:1 propensity score matching was performed to balance the clinicopathological features between the surgery and non-surgery groups. Kaplan-Meier analyses and log-rank tests were used to assess the significance of surgery to outcome, and Cox proportional-hazards regression and competing risk model were conducted to determine the independent prognostic factors for these patients. A nomogram was built using multivariable logistic analyses to predict candidates for surgery based on preoperative factors.

Results

The final study population of 31,462 patients were divided into surgery and non-surgery groups. The median cancer-specific survival time respectively was 53 vs. 13 months. The patients’ age, sex, race, Tumor, Node, Metastasis score, stage, chemotherapy use, tumor histology and nuclear grade were independent prognostic factors. Apart from race and chemotherapy, other variates were included in the predictive model to distinguish the optimal surgical octogenarian candidates with NSCLC. Internal and external validation confirmed the efficacy of this model.

Conclusion

Surgery improved the survival time of octogenarian NSCLC patients. A novel nomogram was built to help clinicians make the decision to perform surgery on elderly patients with NSCLC.