Similar Long-term Survival of Elderly Patients With Non-small Cell Lung Cancer Treated With Lobectomy or Wedge Resection Within the Surveillance, Epidemiology, and End Results Database

Yang

2011

Chin. J. Cancer Res.

Objective: To identify clinical and pathologic factors that were associated with the survival of stage IB upper lobe non-small cell lung cancer (NSCLC) patients.Methods: A retrospective study of 147 subjects who had undergone curative resection for stage IB upper lobe NSCLC was performed. Patients who had received any adjuvant or neo-adjuvant chemotherapy were excluded. Survival function curves were estimated using the Kaplan-Meier procedure. Crude and adjusted hazard ratios (HRs) of potential prognostic factors were estimated using Cox proportional hazards models.Results: Five factors, including age, tumor size, histologic grade of differentiation, number of removed superior mediastinal lymph node stations and presence of visceral pleura invasion, were significantly and independently associated with mortality risk. Adjusted HRs were 2.6 [95% confidence interval (95% CI): 1.1−6.5] and 4.6 (95% CI: 1.9−11) for those aged 58−68 years and those >68 years, respectively, relative to those aged <58 years. HRs for those with poorly and moderately differentiated tumors were 6.4 (95% CI: 2.3−18) and 1.4 (95% CI: 0.7−2.8), respectively. HRs for those with tumor size 3.1−5 cm and >5 cm (vs ≤3.0 cm) were 2.3 (95% CI: 1.1−4.9) and 4.3 (95% CI: 1.9−10), respectively. The presence of visceral pleura invasion also increased the risk of mortality (HR=4.0, 95% CI: 1.3−12).Conclusion: Advanced age, larger tumor size, poorly differentiated histology, smaller number of removed superior mediastinal lymph node stations, and presence of visceral pleura invasion were associated with poor survival of surgically treated stage IB upper lobe NSCLC patients.

Section: Discussionmentioning

confidence: 99%

Prognostic factors for survival of stage IB upper lobe non-small cell lung cancer patients: A retrospective study in Shanghai, China

Yang

2011

Chin. J. Cancer Res.

“…22,23 Although the prognosis of untreated patients is poor, 19 the mortality and morbidity of surgery, combined with the poor results from conventional radiotherapy, led to the widespread perception among patients and physicians that advanced age combined with the presence of comorbidities is a reason to defer from curative treatment. 24,25 Recent publications have reported local control rates for SRT that are in the range reported with surgery; and, notably for a patient cohort with considerable comorbidities, SRT is associated with a low incidence of grade !3 toxicity (Table 3). 5,26,27 Our results in 193 patients aged !75 years indicate that SRT is well tolerated even in patients with significant comorbidity.…”

Section: Discussionmentioning

confidence: 99%

Stage I nonsmall cell lung cancer in patients aged ≥75 years

Haasbeek

Lagerwaard

Antonisse

et al. 2009

Cancer

163

BACKGROUND:The number of patients aged !75 years who present with a stage I nonsmall cell lung cancer (NSCLC) is increasing. Elderly patients often have significant comorbidity and may be unfit for surgery. Furthermore, surgery in the elderly is associated with increased mortality and morbidity. In this study, the authors evaluated the outcomes of stereotactic radiotherapy (SRT) in elderly patients. METHODS: Since 2003, 203 tumors in 193 patients aged !75 years were treated using SRT (118 T1 tumors, 85 T2 tumors). The median patient age was 79 years, 80% of patients were considered medically inoperable, and 20% of patients declined surgery. The median Charlson comorbidity score was 4, and severe chronic obstructive pulmonary disease (Global Initiative for Chronic Obstructive Lung Disease Class III or greater) was present in 25% of patients. Risk-adapted SRT schemes were used with the same total dose of 60 grays in 3 fractions (33%), 5 fractions (50%), or 8 fractions (17% of patients), depending on the patient's risk for toxicity. RESULTS: SRT was well tolerated, and all but 1 patient completed treatment. Survival rates at 1 year and 3 years were 86% and 45%, respectively. Survival was correlated with performance score (P ¼ .001) and pre-SRT lung function (P ¼ .04). The actuarial local control rate at 3 years was 89%. Acute toxicity was uncommon, and late Radiation Therapy Oncology Group grade !3 toxicity was observed in <10% of patients. CONCLUSIONS: SRT achieved high local control rates with minimal toxicity in patients aged !75 years despite their significant medical comorbidities. These results indicated that more active diagnostic and therapeutic approaches are justified in elderly patients and that SRT should be considered and discussed as a curative treatment alternative. Cancer 2010;116:406-14.

European Respiratory Journal

“…SUBLOBAR RESECTIONS FOR SMALL SOLID AND PARTLY SOLID PERIPHERAL TUMOURS Indications Table 1 shows the most relevant data from 20 studies comparing lobectomy with sublobar resection [8,20,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. All but three were retrospective: one was a prospective but nonrandomised study [28] and two were prospective observational studies [20,34].…”

Section: Upper Lobementioning

confidence: 99%

“…However, in six studies from five different institutions, sublobar resections were intentional in patients who could otherwise tolerate a lobectomy [20,25,28,32,37,41]. Most studies were limited to patients with stage I tumours, but three also included higherstage tumours [30,34,40].…”

Section: Upper Lobementioning

confidence: 99%

“…MERY et al [30] studied this issue in the population of patients registered in the Surveillance, Epidemiology, and End Results database of the National Institutes of Health (Bethesda, MD, USA), and compared the results of lobectomy, pneumonectomy and wedge resection in patients aged ,65 yrs, patients aged 65-74 yrs of age and patients aged o75 yrs. Lobectomy conferred significantly better survival in patients of the first two age groups, but in those aged o75 yrs, both lobectomy and wedge resection had similar survival.…”

Section: Agementioning

confidence: 99%

See 1 more Smart Citation

Sublobar resection for lung cancer

Rami–Porta

Tsuboi²

2008

Sublobar resection for small lung cancers has been debated frequently and is still a controversial issue. The only randomised trial comparing lobectomy with sublobar resections found a significantly higher recurrence rate for the latter, but failed to show significant differences in survival, although survival was better for the lobectomy group. One meta-analysis and several nonrandomised comparisons have confirmed these results. In general, lobectomy and sublobar resections have similar 5-yr survival rates. Local recurrence after wedge resection is higher than after segmentectomy. However, for patients aged .71 yrs, lobectomy and wedge resection are associated with similar survival. For tumours of f2 cm, segmentectomy is equivalent to lobectomy, but survival after segmentectomy is worse if performed for larger tumours. For both segmentectomy and wedge resection, tumour margins should be o1 cm wide to avoid recurrence. For pure bronchioloalveolar carcinoma of f2 cm, diagnosed intraoperatively with certainty, sublobar resection seems equivalent to lobectomy, and because there is no nodal involvement, systematic nodal dissection may not be necessary. In case of doubt, however, lobectomy with systematic nodal dissection will ensure complete resection and adequate staging. More randomised trials are needed to confirm all these issues.