Seto Yurie, Kaneko Yoshiko, Mouri Takako, Fujii Hiroyuki, Tanaka Satomi, Shiotsu Shinsuke, Hiranuma Osamu, Morimoto Yoshie, Iwasaku Masahiro, Yamada Tadaaki, Uchino Junji, Takayama Koichi
Department of Pulmonary Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Respiratory Medicine, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan.
Transl Lung Cancer Res. 2021 Jan;10(1):193-201. doi: 10.21037/tlcr-20-894.
Over 40% Japanese patients with lung cancer are above 75 years of age. A specific strategy to treat such older patients is necessary because most trials exclude older patients with poor physical health. Herein, we aimed to identify predictive factors associated with overall survival (OS) in older patients by evaluating patient backgrounds and laboratory data before the start of treatment.
This multicenter retrospective medical chart review study was conducted at three Japanese institutions and involved patients aged 75 years and above with epidermal growth factor receptor (EGFR) mutation-negative advanced non-small cell lung cancer (NSCLC). Of the patients, 75 had received best supportive care (BSC) and 49 mono-chemotherapy or platinum-doublet chemotherapy, including immune checkpoint inhibitors (ICIs). OS after diagnosis was analyzed using the Kaplan-Meier survival analysis. Cox proportional hazard models, which included age, Eastern Cooperative Oncology Group performance status (ECOG PS), staging, serum albumin levels, and receipt of chemotherapy were analyzed.
Age at diagnosis was not shown to be related to OS in patients receiving BSC. In patients aged 81 years and above, the chemotherapy group tended to have longer survival than did the BSC group, but there was no statistically significant difference in the median OS between the two groups due to the very small number of subjects (n: 30 12, median: 52 30 weeks, hazard ratio: 0.512, 95% confidence interval: 0.232-1.130, P=0.088). The patients' performance status and albumin levels at lung cancer diagnosis had the highest impact on OS in the BSC group.
Careful consideration should be given to the indications of chemotherapy for patients aged 81 years and above with wild-type EGFR advanced non-small lung cancer.
超过40%的日本肺癌患者年龄在75岁以上。由于大多数试验排除了身体健康状况较差的老年患者，因此需要一种特定的策略来治疗这类老年患者。在此，我们旨在通过评估治疗开始前的患者背景和实验室数据，确定老年患者总生存期（OS）的预测因素。
这项多中心回顾性病历审查研究在日本的三个机构进行，纳入了75岁及以上表皮生长因子受体（EGFR）突变阴性的晚期非小细胞肺癌（NSCLC）患者。其中，75例患者接受了最佳支持治疗（BSC），49例接受了单药化疗或铂类双联化疗，包括免疫检查点抑制剂（ICI）。采用Kaplan-Meier生存分析对诊断后的OS进行分析。分析了Cox比例风险模型，该模型包括年龄、东部肿瘤协作组体能状态（ECOG PS）、分期、血清白蛋白水平和化疗接受情况。
接受BSC的患者中，诊断时的年龄与OS无关。在81岁及以上的患者中，化疗组的生存期往往比BSC组长，但由于受试者数量极少（n：30对12，中位数：52对30周，风险比：0.512，95%置信区间：0.232-1.130，P = 0.088），两组之间的中位OS没有统计学显著差异。在BSC组中，患者在肺癌诊断时的体能状态和白蛋白水平对OS的影响最大。
对于81岁及以上野生型EGFR晚期非小肺癌患者，应仔细考虑化疗的适应症。
