Gu Yu, Zhang Junhua, Zhou Zhirui, Liu Di, Zhu Hongcheng, Wen Junmiao, Xu Xinyan, Chen Tianxiang, Fan Min
1Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China.
2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China.
Aging Dis. 2020 Feb 1;11(1):82-92. doi: 10.14336/AD.2019.0414. eCollection 2020 Feb.
Non-small cell lung cancer (NSCLC) is the most common cancer and the leading cause of cancer-related deaths worldwide. Age at diagnosis of advanced NSCLC is much older, but studies describing the practice patterns for octogenarians with distant metastasis NSCLC are limited. A retrospective, population-based study using national representative data from the Surveillance, Epidemiology, and End Results (SEER) program was conducted to evaluate 34 882 NSCLC patients with extrathoracic metastases from 2010 to 2013. Patients were classified into three groups (older group: ≥80 yrs, middle-aged group: 60-79 yrs, and younger group: ≤59 yrs). The role of different age at diagnosis of NSCLC in metastasis patterns was investigated, and survival of different age groups of metastatic NSCLC was assessed. The analysis revealed that older patients were more likely to only have bone or liver metastasis (p< 0.001), but less likely to have brain only metastasis (p<0.001) and multiple metastatic sites (p< 0.001) than other two groups. Age at diagnosis was an independent risk factor for different metastasis types. Older group had the worst overall survival (p<0.001) and cancer-specific survival (p<0.001). Furthermore, older age patients with only bone metastasis had the best cancer specific survival (p<0.05) while younger patients with only brain metastasis had the best prognosis (p<0.001). Over 60% octogenarians with metastatic NSCLC did not receive anti-cancer therapy and had the highest rate of cancer deaths among all patients. Our results may help clinicians make positive decisions regarding personalized treatment of metastatic NSCLC in the elderly.
非小细胞肺癌（NSCLC）是全球最常见的癌症，也是癌症相关死亡的主要原因。晚期NSCLC的诊断年龄要大得多，但描述八旬老人远处转移NSCLC治疗模式的研究有限。本研究采用监测、流行病学和最终结果（SEER）计划的全国代表性数据进行了一项基于人群的回顾性研究，以评估2010年至2013年间34882例有胸外转移的NSCLC患者。患者被分为三组（老年组：≥80岁，中年组：60-79岁，青年组：≤59岁）。研究了NSCLC不同诊断年龄在转移模式中的作用，并评估了不同年龄组转移性NSCLC的生存率。分析显示，老年患者仅发生骨或肝转移的可能性更大（p<0.001），但与其他两组相比，仅发生脑转移（p<0.001）和多个转移部位（p<0.001）的可能性更小。诊断年龄是不同转移类型的独立危险因素。老年组的总生存率（p<0.001）和癌症特异性生存率最差（p<0.001）。此外，仅发生骨转移的老年患者癌症特异性生存率最佳（p<0.05），而仅发生脑转移的年轻患者预后最佳（p<0.001）。超过60%的转移性NSCLC八旬老人未接受抗癌治疗，在所有患者中癌症死亡率最高。我们的结果可能有助于临床医生对老年转移性NSCLC的个性化治疗做出积极决策。
