School of Medicine, Shandong University, Jinan, China.
Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China.
Cancer Med. 2019 May;8(5):2587-2598. doi: 10.1002/cam4.2127. Epub 2019 Apr 3.
Locally advanced nonsmall-cell lung cancer (LA-NSCLC) represented a highly heterogeneous group, with more than half of the patients aged ≥65 years at the time of diagnosis. However, the optimal treatment for elderly LA-NSCLC patients was still not defined.
A total of 33530 elderly patients (≥65 years) diagnosed with LA-NSCLC from 2004 to 2014 were identified from Surveillance, Epidemiology, and End Results (SEER) database.
Locally advanced nonsmall-cell lung cancer patients aged 65-74 years were more frequently treated with chemoradiotherapy (CRT) (40%), while patients aged ≥75 years received more best supportive care (BSC) (36%). For age group of 65-74 years, patients who had surgery with or without (neo)adjuvant therapy had a median survival of 28 months, CRT 15 months, radiotherapy (RT) alone 6 months, chemotherapy alone 11 months, and BSC 3 months; while for patients aged ≥ 75 years, the median OS was 20, 13, 7, 9, and 2, respectively. Besides, independent clinicopathological factors were integrated into nomograms for OS and CSS prediction, C-indexes achieved 0.692 and 0.698, respectively. Importantly, the discrimination of nomogram was superior to that of the American Joint Committee on Cancer TNM classification (0.742 vs 0.572 for training set and 0.731 vs 0.565 for validation set).
For elderly patients with LA-NSCLC, the curative-intent treatment (surgery or CRT) conferred better survival compared to chemotherapy alone, RT alone and BSC. The proposed nomograms based on independent clinicopathological variables may be practical and helpful for precise evaluation of patient prognosis, and guiding the individualized treatment for elderly LA-NSCLC.
局部晚期非小细胞肺癌（LA-NSCLC）是一组高度异质性的疾病，超过一半的患者在诊断时年龄≥65 岁。然而，老年局部晚期非小细胞肺癌患者的最佳治疗方法仍未确定。
从 Surveillance，Epidemiology，and End Results（SEER）数据库中确定了 2004 年至 2014 年间诊断为 LA-NSCLC 的 33530 名老年患者（≥65 岁）。
65-74 岁的局部晚期非小细胞肺癌患者更常接受放化疗（CRT）（40%），而≥75 岁的患者接受最佳支持治疗（BSC）（36%）更多。对于 65-74 岁年龄组，接受手术联合或不联合（新）辅助治疗的患者中位生存期为 28 个月，CRT 为 15 个月，单纯放疗（RT）为 6 个月，单纯化疗为 11 个月，BSC 为 3 个月；而对于≥75 岁的患者，中位 OS 分别为 20、13、7、9 和 2 个月。此外，独立的临床病理因素被整合到用于 OS 和 CSS 预测的列线图中，C 指数分别达到 0.692 和 0.698。重要的是，列线图的区分度优于美国癌症联合委员会 TNM 分期（训练集为 0.742 对 0.572，验证集为 0.731 对 0.565）。
对于局部晚期非小细胞肺癌的老年患者，与单纯化疗、单纯放疗和 BSC 相比，以治愈为目的的治疗（手术或 CRT）可带来更好的生存获益。基于独立临床病理变量的列线图可能具有实际意义，有助于对患者预后进行精确评估，并指导老年局部晚期非小细胞肺癌的个体化治疗。
