Yang Chi-Fu Jeffrey, Mayne Nicholas R, Wang Hanghang, Meyerhoff Ryan R, Hirji Sameer, Tong Betty C, Hartwig Matthew, Harpole David, D'Amico Thomas A, Berry Mark
Department of Surgery, Duke University, Durham, North Carolina.
Department of Surgery, Duke University, Durham, North Carolina.
Ann Thorac Surg. 2016 Sep;102(3):962-970. doi: 10.1016/j.athoracsur.2016.03.088. Epub 2016 May 25.
This study analyzes the impact of age on perioperative outcomes and long-term survival of patients undergoing surgery after induction chemotherapy for non-small cell lung cancer.
Short- and long-term outcomes of patients with non-small cell lung cancer who were at least 70 years and received induction chemotherapy followed by major lung resection (lobectomy or pneumonectomy) from 1996 to 2012 were assessed using multivariable logistic regression, Kaplan-Meier, and Cox proportional hazard analysis. The outcomes of these elderly patients were compared with those of patients younger than 70 years who underwent the same treatment from 1996 to 2012.
Of the 317 patients who met the study criteria, 53 patients were at least 70 years. The median age was 74 years (range, 70 to 82 years) in the elderly group, and induction chemoradiation was used in 24 (45%) patients. Thirty-day mortality was similar between the younger (n = 12) and elderly (n = 3) patients (5% versus 6%; p = 0.52). There were no significant differences in the incidence of postoperative complications between younger and elderly patients (49% versus 57%; p = 0.30). Patients younger than 70 years had a median overall survival (30 months; 95% confidence interval [CI], 24 to 43) and a 5-year survival (39%; 95% CI, 33 to 45) that was not significantly different from patients at least 70 years (median overall survival, 30 months; 95% CI, 18 to 68; and 5-year overall survival, 36%; 95% CI, 21 to 51). However, there was a trend toward worse survival in the elderly group after multivariable adjustment (hazard ratio, 1.43; 95% CI, 0.97 to 2.12; p = 0.071).
Major lung resection after induction chemotherapy can be performed with acceptable short- and long-term results in appropriately selected patients at least 70 years, with outcomes that are comparable to those of younger patients.
本研究分析年龄对非小细胞肺癌诱导化疗后接受手术患者围手术期结局及长期生存的影响。
采用多变量逻辑回归、Kaplan-Meier法和Cox比例风险分析，评估1996年至2012年间年龄至少70岁且接受诱导化疗后行肺大部切除术（肺叶切除术或全肺切除术）的非小细胞肺癌患者的短期和长期结局。将这些老年患者的结局与1996年至2012年间接受相同治疗的70岁以下患者的结局进行比较。
在符合研究标准的317例患者中，53例年龄至少70岁。老年组的中位年龄为74岁（范围70至82岁），24例（45%）患者接受了诱导放化疗。年轻患者（n = 12）和老年患者（n = 3）的30天死亡率相似（5%对6%；p = 0.52）。年轻患者和老年患者术后并发症发生率无显著差异（49%对57%；p = 0.30）。70岁以下患者的中位总生存期为30个月（95%置信区间[CI]，24至43），5年生存率为39%（95%CI，33至45），与年龄至少70岁的患者无显著差异（中位总生存期30个月；95%CI，18至68；5年总生存率36%；95%CI，21至51）。然而，多变量调整后老年组生存有变差的趋势（风险比，1.43；95%CI，0.97至2.12；p = 0.071）。
在经过适当选择的至少70岁患者中，诱导化疗后行肺大部切除术可取得可接受的短期和长期结果，其结局与年轻患者相当。
