Decrease in performance status after lobectomy mean poor prognosis in elderly lung cancer patients

Abstract

Background: Surgery remains the best treatment for obtaining cure in patients with resectable lung cancer, regardless of age. In elderly patients, however, the presumed fear of decreased performance status (PS) after lobectomy has resulted in the delivery of sub-optimal cancer surgery. Surgical decision making for such patients would become easier if post-lobectomy survival benefits and changes in PS were well defined. Methods:We reviewed patients aged 75 years or older who received lobectomy for non-small cell lung cancer (NSCLC) at our hospital between January 2004 and December 2014. Eastern Cooperative Oncology Group PS was preoperatively and postoperatively assessed in 137 patients. Patients were classified into 2 groups based on the change in PS: in Group 1, postoperative and preoperative PS were the same; in group 2, postoperative PS was less than preoperative PS. We compared the characteristics of patients in groups 1 and 2.Results: Overall 5-year survival was 47.4% in group 1 and 0% in group 2 (P<0.001). History of cardiac ischemia (P=0.001) and squamous cell carcinoma (P=0.015) were identified as significant predictors of reduced postoperative PS. Conclusions:Our results show that maintenance of PS after lobectomy is expected to be associated with a good prognosis. However, reduction of PS after lobectomy indicates an extremely poor prognosis in elderly patients with lung cancer. History of cardiac ischemia and squamous cell carcinoma are possible risk factors for decreasing PS. Thus, careful patient evaluation and selection are needed when deciding whether to use lobectomy in clinical practice.

Major clinical benefit from adjuvant chemotherapy for stage II–III non-small cell lung cancer patients aged 75 years or older: a propensity score-matched analysis

“…As reported by others, older patients receive adjuvant chemotehrapy less often than younger patients, in spite of a similar survival benefit [ 16 ]. Moreover, the role of PS [ 17 ] as well as nodal status [ 18 ] as important factors influencing the treatment decision in patients with resectable NSCLC is well known.…”

Does sarcopenia affect postoperative short- and long-term outcomes in patients with lung cancer?—a systematic review and meta-analysis

“…Patients with sarcopenia tend to have postoperative complications. The incidence of these complications may strongly predict a poor prognosis because physical ability is decreased by complications, resulting in poor responses to treatment for not only cancer but also other diseases (18). Third, a tumor occurring in sarcopenia patients has a more malignant potential than that occurring in patients without sarcopenia.…”

Circular RNA circ_0067741 regulates the Hippo/YAP pathway to suppress lung adenocarcinoma progression by targeting microRNA-183-5p

“…Compared with other tumors, the incidence and mortality of lung cancer are higher [ 3 ]. At the same time, the treatment of lung cancer still suffered great challenges on account of the metastasis and poor prognosis [ 23 , 24 ]. It is revealed that aberrant expression of transcriptional regulatory genes is closely associated with the emergence and malignant behavior of numerous cancers [ 25 , 26 ].…”