Bolton William D, Rice David C, Correa Arlene M, Hofstetter Wayne, Komaki Ritsuko, Mehran Reza, Pisters Katherine, Roth Jack A, Vaporciyan Ara A, Walsh Garrett L, Swisher Stephen G
Greenville Hospital System, University Medical Center, Department of Cardiovascular Surgery, 701 Grove Road, Greenville, SC 29605, USA.
Am Surg. 2009 Jul;75(7):598-603; discussion 603-4.
United States census data predict expansion of the elderly population until 2050 and nonsmall lung cancer (NSCLC) incidence is expected to rise accordingly. This study examines trends of lung cancer management and outcomes for pulmonary resection of primary NSCLC in the elderly. An institutional data set (n = 5950) was examined to determine patterns of management. A separate surgical dataset (n = 1756) was examined to determine surgical outcomes. "Elderly" was defined as 70 years old or older. Twenty-four per cent of patients in the institutional data set underwent surgery. Patients in the youngest age quartile (younger than 62 years) were more likely to undergo surgery, whereas the oldest quartile (older than 74 years) were less likely. In the surgical data set, 643 patients were elderly. No difference in combined 30-day/in-hospital mortality was noted (4 vs 2.9%). Five-year survival was 59.1 per cent for younger and 49.9 per cent for elderly patients. On multivariable analysis, age 70 years or older, male gender, increasing Charlson Comorbidity Index score, and pathologic stage were predictors of worse survival. Increasing age is an independent rick factor for surgical outcome and long-term survival after pulmonary resection for NSCLC, age appears to influence choice of initial treatment and extent of resection. Although surgery in the elderly carries higher risk, long-term cure can still be achieved in a significant number of patients.
美国人口普查数据预测，到2050年老年人口将不断增加，非小细胞肺癌（NSCLC）的发病率预计也会相应上升。本研究探讨了老年原发性NSCLC肺切除的肺癌管理趋势及预后。通过研究机构数据集（n = 5950）来确定管理模式。通过研究一个单独的手术数据集（n = 1756）来确定手术结果。“老年人”定义为70岁及以上。机构数据集中24%的患者接受了手术。年龄最小四分位数组（小于62岁）的患者更有可能接受手术，而年龄最大四分位数组（大于74岁）的患者则可能性较小。在手术数据集中，643例患者为老年人。30天/住院死亡率合并后无差异（4%对2.9%）。年轻患者的5年生存率为59.1%，老年患者为49.9%。多变量分析显示，70岁及以上、男性、查尔森合并症指数评分增加以及病理分期是生存率较差的预测因素。年龄增长是NSCLC肺切除术后手术结果和长期生存的独立危险因素，年龄似乎会影响初始治疗的选择和切除范围。虽然老年患者手术风险更高，但仍有相当数量的患者能够实现长期治愈。
