Ganti Apar Kishor, Shostrom Valerie, Alorabi Mohamed, Zhen Weining Ken, Marr Alissa S, Trujillo Karin, Islam K M Monirul, Lackner Rudy P, Kessinger Anne
Department of Internal Medicine, VA Nebraska Western Iowa Health Care System, Omaha, NE; Department of Internal Medicine, Division of Oncology/Hematology, University of Nebraska Medical Center, Omaha, NE.
Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE.
Clin Lung Cancer. 2016 Jul;17(4):285-91. doi: 10.1016/j.cllc.2015.11.014. Epub 2015 Dec 1.
The median age at diagnosis of lung cancer is 70 years. However, the evidence guiding the management of octogenarians and older patients with non-small-cell lung cancer (NSCLC), is based on data derived from younger patients and may not be appropriate.
Patients ≥ 80 years diagnosed with clinical stages I and II NSCLC, between 1988 and 2007, were identified from the SEER database. Patients were classified according to treatments received: no treatment, surgery only, radiation only, and surgery + radiation. Factors associated with survival were assessed using the Cox proportional hazards model.
There were 1338 cases of early stage NSCLC in octogenarians. Surgery was the most common treatment modality. The median overall survival was 3.8 years for patients who had surgery, compared with 1.6 years, 1.6 years, and 0.9 years for those who received surgery + radiation, radiation alone, and no treatment, respectively (P < .0001). Factors significantly associated with worse overall survival following surgery included increasing age (hazard ratio [HR], 1.08; P = .0005), male gender (HR, 1.33; P = .01), stage II (HR, 2.21; P < .0001), and squamous histology (HR, 1.36; P = .01).
Surgical resection is associated with long-term survival outcomes in a substantial proportion of octogenarian and older patients with early stage lung cancer and should not be withheld on the basis of age alone.
肺癌诊断的中位年龄为70岁。然而，指导八旬及以上非小细胞肺癌（NSCLC）患者治疗的证据基于较年轻患者的数据，可能并不适用。
从监测、流行病学与最终结果（SEER）数据库中识别出1988年至2007年间诊断为临床I期和II期NSCLC的80岁及以上患者。根据接受的治疗对患者进行分类：未治疗、仅手术、仅放疗以及手术+放疗。使用Cox比例风险模型评估与生存相关的因素。
八旬老人中有1338例早期NSCLC病例。手术是最常见的治疗方式。接受手术的患者中位总生存期为3.8年，而接受手术+放疗、单纯放疗和未治疗的患者分别为1.6年、1.6年和0.9年（P <.0001）。与手术后总体生存较差显著相关的因素包括年龄增加（风险比[HR]，1.08；P =.0005）、男性（HR，1.33；P =.01）、II期（HR，2.21；P <.0001）和鳞状组织学（HR，1.36；P =.01）。
手术切除与相当一部分八旬及以上早期肺癌患者的长期生存结果相关，不应仅基于年龄而拒绝手术。
