Lou Xiaoying, Sanders Andrew, Wagh Kaustubh, Binongo Jose N, Sancheti Manu, Javidfar Jeffrey, Pickens Allan, Fernandez Felix, Force Seth, Khullar Onkar
1371 Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, GA, USA.
1859 Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Innovations (Phila). 2021 Jan-Feb;16(1):68-74. doi: 10.1177/1556984520971620. Epub 2020 Nov 27.
Octogenarians comprise an increasing proportion of patients presenting with non-small-cell lung cancer (NSCLC). This study examines postoperative morbidity and mortality, and long-term survival in octogenarians undergoing thoracoscopic anatomic lung resection for NSCLC, compared with younger cohorts.
We conducted a retrospective review of our institutional Society of Thoracic Surgeons General Thoracic Surgery Database of all patients ≥60 years old undergoing elective lobectomy or segmentectomy for pathologic stage I, II, and IIIA NSCLC between 2009 and 2018. Results were compared between octogenarians ( = 71) to 2 younger cohorts of 60- to 69-year-olds ( = 359) and 70- to 79-year-olds ( = 308). Long-term survival among octogenarians was graphically summarized using the Kaplan-Meier method. Cox regression analysis was used to identify preoperative risk factors for mortality.
A greater proportion of octogenarians required intensive care unit admission and discharge to extended-care facilities; however, postoperative length of stay was similar between groups. Among postoperative complications, arrhythmia and renal failure were more likely in the older cohort. Compared to the youngest cohort, in-hospital and 30-day mortality were highest among octogenarians. Overall survival among octogenarians at 1, 3, and 5 years was 87.3%, 61.8%, and 50.5%, respectively. On multivariable Cox regression analysis of baseline demographic variables, presence of stroke (hazard ratio [HR] = 28.5, 95% confidence interval [CI]: 6.1 to 132.7, < 0.001) and coronary artery disease (HR = 2.5, 95% CI: 1.2 to 5.3, = 0.02) were significant predictors of overall mortality among octogenarians.
Thoracoscopic resection can be performed with favorable early postoperative outcomes among octogenarians. Long-term survival, although comparable to their healthy peers, is worse than those of younger cohorts. Further study into preoperative risk stratification and alternative therapies among octogenarians is needed.
在非小细胞肺癌（NSCLC）患者中，八旬老人所占比例日益增加。本研究旨在比较八旬老人与年轻患者队列接受胸腔镜解剖性肺切除治疗NSCLC后的术后发病率、死亡率及长期生存率。
我们对2009年至2018年间在我院胸外科医师协会普通胸外科数据库中所有年龄≥60岁、因病理分期为I、II和IIIA期NSCLC接受择期肺叶切除术或肺段切除术的患者进行了回顾性研究。将八旬老人（n = 71）与两个较年轻队列（60至69岁，n = 359；70至79岁，n = 308）的结果进行比较。使用Kaplan-Meier方法以图表形式总结八旬老人的长期生存率。采用Cox回归分析确定术前死亡风险因素。
八旬老人中需要入住重症监护病房并转至长期护理机构的比例更高；然而，各组术后住院时间相似。在术后并发症中，老年队列发生心律失常和肾衰竭的可能性更大。与最年轻队列相比，八旬老人的住院死亡率和30天死亡率最高。八旬老人1年、3年和5年的总生存率分别为87.3%、61.8%和50.5%。对基线人口统计学变量进行多变量Cox回归分析时，中风（风险比[HR] = 28.5, 95%置信区间[CI]：6.1至132.7，P < 0.001）和冠状动脉疾病（HR = 2.5, 95% CI：1.2至5.3，P = 0.02）是八旬老人总死亡率的显著预测因素。
八旬老人行胸腔镜切除术可获得良好的早期术后结果。尽管长期生存率与健康同龄人相当，但仍低于年轻队列。需要对八旬老人术前风险分层及替代疗法进行进一步研究。
