No abstract

Objectives To compare overall survival (OS) and cancer-specific survival (CSS) outcomes of surgery with radiotherapy in octogenarians with stage Ia non-small cell lung cancer (NSCLC). Materials and methods Patients aged ≥ 80 years with clinical stage Ia (T1N0M0) NSCLC between 2012 and 2017 were identified from the population-based Surveillance, Epidemiology, and End Results (SEER) database. Patients were assigned into surgery and radiotherapy groups. Multivariate Cox regression analysis was used to identify survival-associated factors. Treatment groups were adjusted by propensity score matching (PSM) analysis while OS and CSS outcomes were compared among groups by Kaplan–Meier analysis. Results A total of 1641 patients were identified, with 46.0% in the surgical group and 54.0% in the radiotherapy group. Compared to surgery, radiotherapy-treated patients were older, later diagnosed, had more often unmarried, more squamous cell carcinoma, more unknown grade and increased tumor sizes. Radiotherapy was associated with a significantly worse OS, compared to surgery (hazard ratio 2.426; 95% CI 2.003–2.939; P < .001). After PSM, OS (P < 0.001) and CSS (P < 0.001) were higher in the surgery group. The 1-, 3-, and 5-year OS rates of surgical and radiotherapy group were 90.0%, 76.9%, 59.9%, and 86.0%, 54.3%, 28.0%, respectively. The 1-, 3-, and 5-year CSS rates of surgical and radiotherapy group were 94.5%, 86.1%, 78.0% and 90.7%, 74.5%, 61.0%, respectively. There were no survival differences between the matched surgery without lymph node examination (LNE) and radiotherapy group, as well as between the matched surgery and radiotherapy who were recommended but refused surgery group. Conclusions In octogenarians with stage Ia NSCLC, surgery with lymph node dissection offers better OS and CSS outcomes than radiotherapy.

Aim To describe pulmonary nodules detected by annual low‐dose computed tomography (LDCT) in the elderly during a 10‐year follow‐up, and to provide a basis for clinical decision‐making in the elderly. Methods In this retrospective study, patients who completed at least a 3‐year follow‐up visit with annual LDCT imaging data were eligible for inclusion. The evolution of pulmonary nodules was evaluated, including malignant, suspicious malignant, benign and undetermined nodules. Additionally, the nature and outcome of new nodules during the follow‐up were analyzed. Results For the 365 subjects included, 899 positive pulmonary nodules were detected in 286 patients. Among these there were 788 solid nodules, 20 part‐solid nodules and 91 nonsolid nodules. The detection rate of positive nodules and of lung cancer was 78.4% and 5.5%, respectively. 99.7% (786/788) of solid nodules were benign, and 75% (15/20) of part‐solid nodules and 28.6% (26/91) of nonsolid nodules were malignant or suspected malignant. 124 new positive nodules appeared during the annual follow‐up, but 58.9% of them subsequently disappeared. Significant higher detection rates of 10–20‐mm nodules (P = 0.0485) and suspicious malignant nodules (P = 0.017) were observed in subjects over 75 years old as compared with those under 75 years old. Conclusions Solid nodules accounted for the highest proportion of lung nodules screened at baseline, and most of them were benign. The malignant probability of part‐solid nodules was the highest. Most newly appeared nodules disappeared during subsequent follow‐up. The proportions of suspicious malignant nodules and 10–20‐mm nodules in subjects over 75 years old were higher than in those under 75 years old. Geriatr Gerontol Int 2022; 22: 865–869.

Objective: To evaluate the safety and efficacy of extended-interval dabigatran dosing in older Chinese patients with non-valvular atrial fibrillation. Methods: We conducted an observational study on non-valvular atrial fibrillation patients administered dabigatran at different dosing intervals at the Department of Geriatrics, Peking University First Hospital, China. We enrolled 121 consecutive non-valvular atrial fibrillation patients aged ≥60 years on dabigatran therapy (mean age, 79.6 ± 7.4 years); they were administered conventional low-dose dabigatran (110 mg twice daily) or extended-interval dosing with dabigatran (110 mg every 16 h or every 24 h). All patients received follow-up care, and we evaluated the presence of bleeding and thromboembolic events. Results: All patients exhibited creatinine clearance greater than 30 mL/min with an average of 56.6 ± 17.3 mL/min. Sixty-two patients received extended-interval dosing with dabigatran at a mean dose of 117.1 ± 18.6 mg daily. Patients on extended-interval dosing were older; they exhibited lower creatinine clearance and bodyweight and higher CHA2DS2-VASc and HAS-BLED scores. The mean follow-up time was 25.8 ± 15.6 months. No significant differences were observed in the trough and peak values of the activated partial thromboplastin time and in thromboembolic or bleeding events between the 2 groups. Conclusion: Extended-interval dabigatran dosing in older patients with non-valvular atrial fibrillation and lower creatinine clearance can maintain activated partial thromboplastin time trough and peak values comparable to the conventional low dose. Physician-prescribed practices regarding dabigatran dosing intervals do not lead to worse outcomes in the above-mentioned population.

Purpose To compare the overall survival (OS) and cancer-specific survival (CSS) of surgery with radiotherapy in octogenarians with stage Ⅰa non–small cell lung cancer (NSCLC). Methods Patients aged ≥ 80 years with clinical stage Ⅰa (T1N0M0) NSCLC from 2012 to 2017 were identified from the population-based Surveillance, Epidemiology, and End Results (SEER) database. Included patients were divided into surgery and radiotherapy group. Multivariate Cox regression was used to identify factors associated with survival. Propensity score‑matching (PSM) analysis was used to adjust treatment groups. OS and CSS were compared among groups by the Kaplan–Meier analysis. Results A total of 1641 patients were identified, with 46.0% received surgery and 54.0% radiotherapy. Compared with surgery, patients treated with radiotherapy were older, later diagnosed, and had more squamous cell carcinoma, unknown grade and increased tumor size. Radiotherapy was associated with a significantly worse OS as compared with surgery (hazard ratio 2.426; 95% CI, 2.003 to 2.939; P < .001). After PSM, the OS (P < 0.001) and CSS (P < 0.001) was higher in the surgery group. The 1-, 3-, and 5-year OS rates of surgery and radiotherapy group were 90.0%, 76.9%, 59.9%, and 86.0%, 54.3%, 28.0%, respectively. The 1-, 3-, and 5-year CSS rates of surgery and radiotherapy group were 94.5%, 86.1%, 78.0% and 90.7%, 74.5%, 61.0%, respectively. No differences in the OS (P = 0.146) and CSS (P = 0.675) were found between the matched surgery without lymph node examination (LNE) and radiotherapy group. Conclusions Surgery with lymph node dissection offers better OS and CSS than radiotherapy in octogenarians with stage Ⅰa NSCLC.