Thomas Pascal-Alexandre, Couderc Anne-Laure, Boulate David, Greillier Laurent, Charvet Aude, Brioude Geoffrey, Trousse Delphine, D'Journo Xavier-Benoit, Barlesi Fabrice, Loundou Anderson
Aix-Marseille University & Assistance Publique-Hôpitaux de Marseille, Department of Thoracic Surgery, North Hospital, Marseille, France; Predictive Oncology Laboratory, CRCM, Inserm UMR 1068, CNRS, UMR 7258, Aix-Marseille University UM105, Marseille, France.
Assistance Publique-Hôpitaux de Marseille, Department of Internal Medicine, Geriatric and Therapeutic, Sainte Marguerite Hospital, AP-HM, Marseille, France; Coordination Unit for Geriatric Oncology (UCOG), PACA West, France; Aix-Marseille University, CNRS, EFS, ADES, Marseille, France.
Lung Cancer. 2021 Feb;152:86-93. doi: 10.1016/j.lungcan.2020.12.009. Epub 2020 Dec 14.
We investigated on the benefit/risk ratio of surgery in octogenarians with early-stage non-small cell lung cancer (NSCLC).
From 2005-2020, 100 octogenarians were operated on for a clinical stage IA to IIA NSCLC. All patients had undergone whole body PET -scan and brain imaging. Operability was assessed according to current guidelines regarding the cardiopulmonary function. Since 2015, patients followed a dedicated geriatric evaluation pathway. Minimally invasive approaches were used in 66 patients, and a thoracotomy in 34.
Clavien-Dindo grade ≥ 4 complications occurred in 15 patients within 90 days, including 7 fatalities. At multivariable analysis, the number of co-morbidities was their single independent prognosticator. Following resection, 24 patients met pathological criteria for adjuvant therapy among whom 3 (12.5 %) received platinum-based chemotherapy. Five-year survival rates were overall (OS) 47 ± 6.3 %, disease-free (DFS) 77.6 ± 5.1 %, and lung cancer-specific (CSS) 74.7 ± 6.3 %. Diabetes mellitus impaired significantly long-term outcomes in these 3 dimensions. OS was improved since the introduction of a dedicated geriatric assessment pathway (72.3 % vs. 6.4 %, P = 0.00002), and when minimally invasive techniques were used (42.3 % vs. 11.3 %; P = 0.02). CSS was improved by the performance of systematic lymphadenectomy (55.3 % vs. 26.9 %; P = 0.04). Multivariable and recursive partitioning analyses showed that a decision tree could be built to predict overall survival on the basis of diabetes mellitus, high co-morbidity index and low ppoDLCO values.
The introduction of a dedicated geriatric assessment pathway to select octogenarians for lung cancer surgery was associated with OS values that are similar to outcomes in younger patients. The use of minimally invasive surgery and the performance of systematic lymphadenectomy were also associated with improved long-term survival. Octogenarians with multiple co-morbid conditions, diabetes mellitus, or low ppo DLCO values may be more appropriately treated with SBRT.
我们研究了手术治疗老年早期非小细胞肺癌（NSCLC）的获益/风险比。
2005年至2020年期间，100例老年患者接受了临床I A期至II A期NSCLC手术。所有患者均接受了全身PET扫描和脑部成像。根据当前关于心肺功能的指南评估手术可操作性。自2015年起，患者遵循专门的老年评估路径。66例患者采用了微创方法，34例采用了开胸手术。
15例患者在90天内出现Clavien-Dindo≥4级并发症，其中7例死亡。多变量分析显示，合并症数量是唯一的独立预后因素。切除术后，24例患者符合辅助治疗的病理标准，其中3例（12.5%）接受了铂类化疗。5年总生存率（OS）为47±6.3%，无病生存率（DFS）为77.6±5.1%，肺癌特异性生存率（CSS）为74.7±6.3%。糖尿病在这三个维度上显著损害了长期预后。自引入专门的老年评估路径后，OS有所改善（72.3%对6.4%，P = 0.00002），使用微创技术时也有所改善（42.3%对11.3%；P = 0.02）。系统性淋巴结清扫术的实施改善了CSS（55.3%对26.9%；P = 0.04）。多变量和递归划分分析表明，可以构建一个决策树，根据糖尿病、高合并症指数和低ppoDLCO值来预测总生存率。
引入专门的老年评估路径以选择老年患者进行肺癌手术，其OS值与年轻患者的结果相似。使用微创手术和实施系统性淋巴结清扫术也与改善长期生存相关。合并多种疾病、患有糖尿病或ppo DLCO值低的老年患者可能更适合接受立体定向体部放疗（SBRT）。
