Hong Seokbeom, Moon Young Kyu, Park Jae Kil
Department of Thoracic and Cardiovascular Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea.
Korean J Thorac Cardiovasc Surg. 2018 Oct;51(5):312-321. doi: 10.5090/kjtcs.2018.51.5.312. Epub 2018 Oct 5.
Treatment strategies for octogenarians with lung cancer remain controversial. The purpose of this study was to compare surgical outcomes and survival between octogenarians and younger patients with stage IA and IB lung cancer.
We reviewed the medical records of 34 consecutive octogenarians and 457 younger patients (<70 years) with stage I lung cancer who underwent surgical resection from January 2007 to December 2015. We analyzed the survival and surgical outcomes of the 2 groups according to the lung cancer stage (IA and IB).
The only significant differences in the clinicopathological features between the groups were the higher proportion of sublobar resection (56.3% vs. 18.9%) and the smaller number of dissected lymph nodes (LNs) in octogenarians. There was no significant difference in hospital stay (11 days vs. 9 days), pneumonia (5.8% vs 1.9%), or operative mortality (0% vs 0.6%) between the 2 groups. Among patients with stage IA lung cancer, 5-year recurrence-free survival was not significantly different between the octogenarians (n=16) and younger patients (n=318) (86.2% vs. 89.1%, p=0.548). However, 5-year overall survival was significantly lower in octogenarians than in younger patients (79.4% vs. 93.4%, p=0.009). Among patients with stage IB lung cancer, there was no significant difference in 5-year recurrence-free survival (62.1% vs. 73.5%, p=0.55) or overall survival (77.0% vs 85.0%, p=0.75) between octogenarians (n=18) and younger patients (n=139). In multivariable analysis, male sex, the number of dissected LNs, and tumor size were factors related to survival (hazard ratio [HR], 5.795; p=0.017; HR, 0.346, p=0.025; and HR, 1.699; p=0.035, respectively).
Surgical outcomes and survival after pulmonary resection for stage I lung cancer were comparable in octogenarians and younger patients. Continued careful selection of octogenarians for pulmonary resection is important to achieve good results.
老年肺癌患者的治疗策略仍存在争议。本研究的目的是比较老年和年轻的IA期及IB期肺癌患者的手术结果和生存率。
我们回顾了2007年1月至2015年12月期间连续接受手术切除的34例老年和457例年龄小于70岁的I期肺癌患者的病历。我们根据肺癌分期（IA期和IB期）分析了两组患者的生存情况和手术结果。
两组患者临床病理特征的唯一显著差异是老年患者肺叶下切除的比例较高（56.3%对18.9%），清扫淋巴结的数量较少。两组患者的住院时间（11天对9天）、肺炎发生率（5.8%对1.9%）或手术死亡率（0%对0.6%）无显著差异。在IA期肺癌患者中，老年患者（n = 16）和年轻患者（n = 318）的5年无复发生存率无显著差异（86.2%对89.1%，p = 0.548）。然而，老年患者的5年总生存率显著低于年轻患者（79.4%对93.4%，p = 0.009）。在IB期肺癌患者中，老年患者（n = 18）和年轻患者（n = 139）的5年无复发生存率（62.1%对73.5%，p = 0.55）或总生存率（77.0%对85.0%，p = 0.75）无显著差异。多因素分析显示，男性、清扫淋巴结数量和肿瘤大小是与生存相关的因素（风险比[HR]分别为5.795，p = 0.017；HR为0.346，p = 0.025；HR为1.699，p = 0.035）。
老年和年轻I期肺癌患者肺切除术后的手术结果和生存率相当。持续谨慎选择老年患者进行肺切除对于取得良好效果很重要。
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