Ma Haibo, Yao Di, Cheng Jiwei, Wang Wei, Liu Baoxing, Yu Yongkui, Xing Wenqun, Qin Jianjun
Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.
Information Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
J Thorac Dis. 2022 Jun;14(6):2178-2186. doi: 10.21037/jtd-22-505.
Various reports showed some conflicting data on survival at different ages. This study aimed to investigate the main cause of death in older patients with lung cancer and to perform a comparison with younger patients in order to observe the differences between these two cohorts.
Outcomes of patients with stage IA non-small cell lung cancer (NSCLC) ≤3 cm who underwent lobectomy without induction therapy in the Surveillance, Epidemiology, and End Results-18 (SEER-18; January 2004 to December 2016) database were evaluated using multivariable Cox proportional hazards modeling and propensity score-matched analysis.
A total of 16,672 eligible NSCLC cases were found in the SEER database. The number of patients aged ≤60, 61-70, and ≥71 years was 3,930, 6,391, and 6,351, respectively. Among these patient groups, 527 (13.4%), 1,018 (15.9%), and 1,235 (19.4%) died of lung cancer during follow-up, while 357 (9.1%), 964 (15.1%) and 1,579 (25.2%) died of non-lung cancer diseases, respectively. The overall survival (OS) and lung cancer-specific survival (LCSS) rates of younger patients showed a significant survival advantage over older patients. After propensity-score matching (PSM) of patients aged ≤60 and ≥71 years using a ratio of 1:1, we found that 403 (12.9%) and 584 (18.7%) patients in the ≤60 and ≥71 years age groups died of lung cancer, respectively. The OS and LCSS rates of younger patients still exhibited a significant survival advantage over older patients.
Older patients with stage IA NSCLC have a worse prognosis compared with younger patients. Also, cancer-related causes were more frequent in older patients than non-cancer-related causes.
各种报告显示，不同年龄段的生存率数据存在一些相互矛盾之处。本研究旨在调查老年肺癌患者的主要死亡原因，并与年轻患者进行比较，以观察这两个队列之间的差异。
利用多变量Cox比例风险模型和倾向评分匹配分析，对监测、流行病学和最终结果-18（SEER-18；2004年1月至2016年12月）数据库中接受肺叶切除术且未接受诱导治疗的IA期非小细胞肺癌（NSCLC）≤3 cm患者的结局进行评估。
在SEER数据库中总共发现了16672例符合条件的NSCLC病例。年龄≤60岁、61-70岁和≥71岁的患者人数分别为3930例、6391例和6351例。在这些患者组中，分别有527例（13.4%）、1018例（15.9%）和1235例（19.4%）在随访期间死于肺癌，而分别有357例（9.1%）、964例（15.1%）和1579例（25.2%）死于非肺癌疾病。年轻患者的总生存率（OS）和肺癌特异性生存率（LCSS）显示出比老年患者显著的生存优势。在对年龄≤60岁和≥71岁的患者按1:1的比例进行倾向评分匹配（PSM）后，我们发现年龄≤60岁和≥71岁年龄组分别有403例（12.9%）和584例（18.7%）患者死于肺癌。年轻患者的OS和LCSS率仍然显示出比老年患者显著的生存优势。
与年轻患者相比，IA期NSCLC老年患者的预后更差。此外，老年患者中与癌症相关的原因比非癌症相关的原因更常见。
