Schulkes Karlijn J G, Pouw Carin A M, Driessen Elisabeth J M, van Elden Leontine J R, van den Bos Frederiek, Janssen-Heijnen Maryska L G, Lammers Jan-Willem J, Hamaker Marije E
Department of Geriatric Medicine, Diakonessenhuis, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands.
Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands.
Lung. 2017 Oct;195(5):627-634. doi: 10.1007/s00408-017-0026-1. Epub 2017 Jun 19.
An important step in improving research and care for the oldest patients with lung cancer is analyzing current data regarding diagnostic work-up, treatment choices, and survival.
We analyzed data on lung cancer from the Netherlands Cancer Registry (NCR-IKNL) regarding diagnostic work-up, treatment, and survival in different age categories; the oldest old (≥85 years of age) versus those aged 71-84 (elderly) and those aged ≤70 years (younger patients).
47,951 patients were included in the 2010-2014 NCR database. 2196 (5%) patients were aged ≥85 years. Histological diagnosis was obtained significantly less often in the oldest old (38%, p < 0.001), and less standard treatment regimen was given (8%, p < 0.001) compared to elderly and younger patients. 67% of the oldest old received best supportive care only versus 38% of the elderly and 20% of the younger patients (p < 0.001). For the oldest old receiving standard treatment, survival rates were similar in comparison with the elderly patients. In the oldest old, no survival differences were found when comparing standard or adjusted regimens for stage I and IV NSCLC; for stage III, oldest old receiving standard treatment had longer survival. No oldest old patients with stage II received standard treatment.
Clinicians make limited use of diagnostics and invasive treatment in the oldest old; however, selected oldest old patients experienced similar survival rates as the elderly when receiving some form of anticancer therapy (standard or adjusted). More research is needed to further develop individualized treatment algorithms.
改善对老年肺癌患者的研究与护理的重要一步是分析有关诊断检查、治疗选择和生存情况的现有数据。
我们分析了荷兰癌症登记处（NCR-IKNL）中不同年龄组肺癌患者的诊断检查、治疗和生存数据；年龄最大的老年人（≥85岁）与71-84岁的老年人以及年龄≤70岁的年轻患者。
2010-2014年NCR数据库纳入了47951例患者。2196例（5%）患者年龄≥85岁。与老年和年轻患者相比，年龄最大的老年人获得组织学诊断的频率显著更低（38%，p<0.001），接受标准治疗方案的比例也更低（8%，p<0.001）。67%的年龄最大的老年人仅接受最佳支持治疗，而老年患者为38%，年轻患者为20%（p<0.001）。对于接受标准治疗的年龄最大的老年人，其生存率与老年患者相似。在年龄最大的老年人中，比较I期和IV期非小细胞肺癌的标准或调整方案时，未发现生存差异；对于III期，接受标准治疗的年龄最大的老年人生存期更长。没有II期年龄最大的老年患者接受标准治疗。
临床医生在年龄最大的老年人中对诊断和侵入性治疗的使用有限；然而，部分年龄最大的老年患者在接受某种形式的抗癌治疗（标准或调整）时，其生存率与老年患者相似。需要更多研究来进一步制定个体化治疗方案。
