Resections for Elderly Patients With Lung Cancer Appears

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By Mike Fillon

CHICAGO, IL -- January 31, 2006 -- Elderly patients undergoing pulmonary resection for non-small-cell lung cancer (NSCLC) appear to have clinical outcomes and long-term survival rates that are similar to those seen in younger patients with similar disease profiles.

These results were presented here January 31st at the Society of Thoracic Surgeons (STS) 42nd Annual Meeting.

The nested case-control study was conducted by Robert J. Cerfolio, MD, Chief of Thoracic Surgery, University of Alabama, Birmingham, Alabama, United States, and his associate, Ayesha S. Bryant, MD, Statistician, Cardiovascular and Thoracic Surgery Department, UAB.

The researchers evaluated the effect of age on morbidity, mortality and long-term survival of complete pulmonary resection for NSCLC in 363 elderly patients.

Patients were subdivided into three age groups: 140 patients who were 7-74, 172 patients who were 75-79 years, and 51 who were 80 years or older. Each patient was matched with a younger control patient according to disease stage, performance status, pulmonary function and type of resection. The median age for the control patients was 60 years.

"We compared elderly patients who were in good shape," said Dr. Cerfolio.

No differences were noted between any of the elderly groups and controls pertaining to length of hospital stay, major morbidity, or mortality during the procedures. The researchers noted prior neoadjuvant therapy was associated with three-fold higher incidence of major morbidity.

Dr. Cerfolio said they were surprised to find that among patients with Stage I NSCLC, long-term survival rates were "significantly superior" in elderly patients, who demonstrated a 78% 5-year survival rate compared with 69% among the younger controls. No other disease stages were associated with different survival outcomes according to age.

Although the findings were similar to those of previous studies, Dr. Cerfolio said his study consisted of a larger series with carefully chosen controls and all procedures performed by one surgeon, "which limits confounders."

Medically fit patients as old as 80 should undergo pulmonary resection for lung cancer, regardless of their chronological age, Dr. Cerfolio said. "All that matters is their risks of surgery and the benefits of resection based on the stage of their disease," he added.

Surgical resection remains the treatment of choice for many patients with NSCLC, but several factors should be considered and weighed when selecting patients for the procedure, Dr. Cerfolio. The suitability of the tumor for resection should be determined based on primary tumor characteristics and the presence of lymph node or distant metastases, he added.

[Presentation title: Survival and Outcomes of Pulmonary Resection for Non-Small-Cell Lung Cancer in the Elderly - A Nested Case-Control Study Abstract 42]