Treatment and outcomes of non-small-cell lung cancer patients with high comorbidity

Abstract

BackgroundThe life expectancy of untreated non-small-cell lung cancer (NSCLC) is dismal, while treatment for NSCLC improves survival. The presence of comorbidities is thought to play a significant role in the decision to treat or not treat a given patient. We aim to evaluate the association of comorbidities with the survival of patients treated for NSCLC.MethodsWe performed a retrospective study of patients aged ≥66 years with invasive NSCLC between the years 2007 and 2011 in the Surveillance, Epidemiology, and End Results Kentucky Cancer Registry. Comorbidity was measured using the Klabunde Comorbidity Index (KCI), and univariate and multivariate logistic regression models were used to measure association between receiving treatment and comorbidity. Kaplan–Meier plots were constructed to estimate time-to-event outcomes.ResultsA total of 4014 patients were identified; of this, 94.9% were white and 55.7% were male. The proportion of patients who did not receive any treatment was 8.7%, 3.9%, 19.1%, and 23.5% for stages I, II, III, and IV, respectively (p<0.0001). In multivariate analysis, older age, higher stage, and higher comorbidity (KCI ≥3) were associated with a lower likelihood of receiving any treatment. The median overall survival (OS) for untreated and KCI=0 was 17.7 months for stages I and II, 2.3 months for stage III, and 1.3 months for stage IV. The median OS for treated and KCI=0 was 58.9 months for stages I and II, 16.8 months for stage III, and 5.8 months for stage IV (p<0.01). Treatment was an independent predictor of OS in multivariate analysis that included KCI scores.ConclusionOur data suggest that lung cancer patients may derive a survival benefit from therapies, regardless of the presence of comorbidities, although the degree of benefit seems to decrease with higher KCI scores.

Down-regulation of microRNA-144-3p and its clinical value in non-small cell lung cancer: a comprehensive analysis based on microarray, miRNA-sequencing, and quantitative real-time PCR data

“…Although great progress has been made in the early detection, diagnosis, and targeted treatments of NSCLC, the five-year survival rates are still low, varying from 4 to 17% depending on regional differences and the disease stage [3–5]. Patients with severer tumor and comorbidity burdens are at a higher risk of death from not receiving effective or specific treatments [6]. Thus, the understanding of the molecular mechanisms in NSCLC and the identification of new therapeutic targets are crucial.…”

To Evaluate the Safety and Efficacy of Drug‐eluting Beads Bronchial Arterial Chemoembolization Loaded with Pirarubicin in the Treatment of Advanced Non-small-cell Lung Cancer

“…For the advanced NSCLC patients with comorbidities, choosing an appropriate therapy is particularly important for improving the quality of life, reducing treatment-related complications, thereby prolonging the survival time of patients [8,9,10]. The advanced NSCLC with sensitive alterations (echinoderm microtubule-associated protein-like 4-anaplastic lymphoma kinase and epidermal growth factor receptor), ALK inhibitors and EGFR-tyrosine kinase inhibitors were widely used clinically as a rst-line therapy [11,12,13].…”

Risk Factors for Short-Term Lung Cancer Survival

“…Second, although the models are robust, possible interactions between the clinical/epidemiological risk factors have also not been taken into consideration. Consequently, a study of these interactions and the aforementioned variables would be of interest to develop and validate better models for classifying survival times of less than one year [ 15 , 31 , 32 , 33 ]. Finally, the number of patients susceptible to surgery, in other words diagnosed at an early stage, also needs to be increased in order to be able to establish therapeutic groups.…”