Factors Determining the Choice of Surgical Procedure in Elderly Patients with Non-Small Cell Lung Cancer

Okamoto, Junichi; Kubokura, Hirotoshi; Usuda, Jitsuo

doi:10.5761/atcs.oa.15-00365

Cited by 13 publications

(9 citation statements)

References 18 publications

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“…However, limited resections like wedges and segmentectomies have recently been reconsidered (32)(33)(34), particularly in the elderly and high-risk population. The previously well documented overall survival benefits of lobectomy over limited resections are not observed in patients older than 75 years (25,(35)(36)(37).…”

Section: General Considerationsmentioning

confidence: 99%

Lung cancer in elderly patients

et al. 2016

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Section: General Considerationsmentioning

confidence: 99%

Lung cancer in elderly patients

et al. 2016

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“…In published literature, we can find results contradictory to these. Different studies have reported statistical significance of stage, smoking history, FEV 1 value, ASA score, CCI and postoperative morbidity in predicting overall survival (6,8,10,12), but none of these studies evaluated the significance of the GPS. The relevance of the established and it is considered a useful predictor of both morbidity and mortality (3).…”

Section: Discussionmentioning

confidence: 99%

“…Several studies concluded that there is no difference in the survival of elderly patients who undergo a limited resection compared to those who undergo lobectomy (5,6,10,14,15). Pneumonectomy, on the other hand, is associated with significantly higher morbidity and mortality among the elderly (5,12,14). To further support this correlation between extent of resection, mortality and age, the study by Mery et al (14) reported that below 71 years of age, the difference in survival among patients who undergo wedge resection versus those who undergo lobectomy does become significant.…”

Section: Gps As a Prognostic Indicator In Cancer Patients Is Widelymentioning

confidence: 99%

Comparison of preoperative scores predicting outcome in elderly undergoing lung malignancies resection

Souza¹,

Bassi²,

Mantovani³

et al. 2020

J Thorac Dis

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Background: Increased age of cancer patients is not an absolute contraindication to pulmonary resection.Different scores have been developed to determine the risk of morbidity and mortality. We have compared four scores in a series of elderly patients with primary or metastatic lung neoplasms who underwent pulmonary resection. Methods: Data from 150 patients with an age equal or more than 75 years were reviewed. Mean age was 78.3 (range, 75-86) years. Based on medical history and preoperative tests 4 predicting scores were calculated. Statistical analysis was performed to identify which score correlates better with postoperative morbidity and mortality.Results: Mortality at 30 days was observed in 3 patients (2%). Postoperative morbidity was observed in 38 patients (25.3%). Univariate analysis showed that risk factors significantly predicting the onset of postoperative complications were type of resection (P=0.02), American Society of Anesthesiology (ASA) score (P<0.001) and Glasgow Prognostic Score (GPS) (P=0.02). At multivariate analysis smoking and type of resection were significant prognostic factors for both overall and pulmonary morbidity; the ASA score and GPS showed an impact only on overall morbidity. The Cox regression showed significant results for GPS greater than zero and cancer-related death. Age above 80 years was not a negative prognostic factor. A significant difference in terms of 1-year survival was noted in ASA I-II vs. ASA III-IV (90% vs. 78%; P=0.022) and GPS 0 vs. GPS 1 or 2 (90% vs. 77%; P=0.02). Conclusions: Prognostic scores are useful to predict postoperative morbidity and mortality and GPS seems to correlate better with them.

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“…Lobectomy is considered as a standard surgical procedure in the treatment of early stage NSCLC even in patients with a tumor size less than or equal to 1 cm. 23 , 24 However, some studies have reported that sublobectomy, including wedge resection and segmentectomy, did not have inferior outcomes compared with lobectomy, although they were less invasive and reserved more normal lung tissues in some cases. 25 , 26 Regardless of the tumor size, we noticed that patients with stage I ASC who underwent lobectomy had better survival outcomes than those who only underwent sublobectomy in our study.…”

Section: Discussionmentioning

confidence: 99%

Treatment for Patients With Early Stage Adenosquamous Lung Cancer

Hui

et al. 2020

JTO Clinical and Research Reports

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Introduction: Adenosquamous lung cancer (ASC) is a rare type of NSCLC with poor prognosis. There is no consensus on the necessity of adjuvant chemotherapy and the selection of surgical procedures for patients with early stage lung cancer. Few studies have investigated the treatment for early stage ASC. Methods: All cases of TNM stage I ASC as per the seventh edition of the American Joint Committee on Cancer staging system were identified from the Surveillance, Epidemiology, and End Results database from 2004 to 2016. The prognostic factors of the primary cohort were identified. Clinical characteristics, first-line treatments, surgical procedures, and survival data, including overall survival and cancerspecific survival, were analyzed. Results: A total of 1251 patients were included. The mean age of the patients was 70 years (±9.5 y). Male and white patients accounted for larger proportions. There were 656 and 595 patients with stages IA and IB, respectively. The mean tumor size was 26.2 mm (±10.7 mm). With respect to the treatment, 139 patients who received only chemotherapy had the worst prognosis. Similar outcomes were observed in both the surgery and adjuvant therapy groups. Nevertheless, adjuvant chemotherapy could improve survival outcomes of patients with a tumor size of 4 to 5 cm. Of the 1075 patients who underwent surgery, there were 224 cases of sublobar resection, 834 cases of lobectomy, and 17 cases of extended or sleeve lobectomy. The results revealed that patients who underwent lobectomy had better prognosis. Conclusions: Early stage ASC has a poor prognosis. Adjuvant chemotherapy was found to have no considerable benefit in patients with stage I disease (eighth edition). Lobectomy or other radical surgeries are recommended as they can improve overall survival of patients with ASC.

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Factors Determining the Choice of Surgical Procedure in Elderly Patients with Non-Small Cell Lung Cancer

Cited by 13 publications

References 18 publications

Lung cancer in elderly patients

Lung cancer in elderly patients

Comparison of preoperative scores predicting outcome in elderly undergoing lung malignancies resection

Treatment for Patients With Early Stage Adenosquamous Lung Cancer

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