Brown J S, Eraut D, Trask C, Davison A G
Department of Thoracic Medicine, Southend Hospital, Westcliff-on-Sea, UK.
Thorax. 1996 Jun;51(6):564-8. doi: 10.1136/thx.51.6.564.
The average age of patients with lung cancer is increasing and there are large numbers of elderly symptomatic patients with this common disease. However, there are few data on how the treatment of this group differs from that of younger patients.
From 1 January 1990 information was collected for the Southend Lung Cancer Registry on all patients with a diagnosis of lung cancer in a geographically well defined health district of the UK with a population of 325,000. Every effort was made to find new cases from all departments of the hospital, including all clinical diagnoses, histopathological and cytological reports, and necropsies. All death certificates in the district were examined, irrespective of age, for any diagnosis of lung cancer. This therefore included any patient not seen by the hospital services. The differences in initial treatment have been analysed for three age groups: under 65, 65-74 years, and over 75.
The 563 cases of lung cancer diagnosed during a 30 month period were included in the study, of whom 240 (43%) were aged over 75 years. The overall mean age was 71 years (range 31-95). The incidence of lung cancer in the general population was 69 per 100,000, but in men over 75 years of age it rose to 751 per 100,000. For all patients the active treatment rate (chemotherapy, surgery, or radiotherapy) was 49%, but for patients not reviewed by a chest physician (n = 86) it was only 21%. There were large differences in initial treatment between age groups. For patients with non-small cell lung cancer (NSCLC) reviewed by a chest physician, surgery was undertaken in 18% of those under 65, 12% of the 65-74 age group, and 2.1% of those over 75. For patients with small cell lung cancer (SCLC) reviewed by a chest physician, 79% of those aged under 65, 64% of the 65-74 age group, and 41% of patients aged over 75 received chemotherapy. In patients with NSCLC reviewed by a chest physician, chemotherapy was given to 21% under 65, 6.4% in the 65-74 age group, and none over 75. If no histological diagnosis was made 37% of patients aged under 75 and only 5.4% of those over 75 received either surgery, radiotherapy, or chemotherapy. Patients not reviewed by a chest physician were less likely to have had a histological diagnosis. Differences in treatment rates with age persisted even after allowing for performance score status at presentation.
Lung cancer is a common disease in the elderly and, in our district, 43% of patients were aged 75 or over at presentation. Age alone appeared to be a major factor in influencing treatment choices, and treatment was more likely if histological confirmation was obtained. Further detailed analysis of the reasons for the differences is needed. Patients referred to chest physicians were more likely to have both histological confirmation and active treatment. This study supports the contention that all patients with a diagnosis of lung cancer, irrespective of age or condition, should be assessed by an accredited chest physician.
肺癌患者的平均年龄在增加，有大量患有这种常见疾病的老年有症状患者。然而，关于该群体的治疗与年轻患者的治疗有何不同的数据很少。
从1990年1月1日起，为绍森德肺癌登记处收集了英国一个地理区域明确、人口为32.5万的健康区内所有诊断为肺癌患者的信息。尽一切努力从医院的所有科室查找新病例，包括所有临床诊断、组织病理学和细胞学报告以及尸检。对该地区所有死亡证明进行检查，不论年龄，查找任何肺癌诊断。因此这包括未接受医院诊治的任何患者。对三个年龄组（65岁以下、65 - 74岁和75岁以上）的初始治疗差异进行了分析。
在30个月期间诊断出的563例肺癌病例纳入了研究，其中240例（43%）年龄在75岁以上。总体平均年龄为71岁（范围31 - 95岁）。普通人群中肺癌发病率为每10万人69例，但75岁以上男性中升至每10万人751例。所有患者的积极治疗率（化疗、手术或放疗）为49%，但未由胸科医生诊治的患者（n = 86）仅为21%。年龄组之间初始治疗存在很大差异。对于由胸科医生诊治的非小细胞肺癌（NSCLC）患者，65岁以下患者中有18%接受了手术，65 - 74岁年龄组为12%，75岁以上为2.1%。对于由胸科医生诊治的小细胞肺癌（SCLC）患者，65岁以下患者中有79%、65 - 74岁年龄组为64%、75岁以上患者为41%接受了化疗。在由胸科医生诊治的NSCLC患者中，65岁以下患者中有21%接受了化疗，65 - 74岁年龄组为6.4%，75岁以上无一人接受化疗。如果未进行组织学诊断，75岁以下患者中有37%接受了手术、放疗或化疗，而75岁以上患者中仅为5.4%。未由胸科医生诊治的患者进行组织学诊断的可能性较小。即使考虑到就诊时的体能状态评分，治疗率随年龄的差异仍然存在。
肺癌在老年人中是一种常见疾病，在我们地区，43%的患者就诊时年龄在75岁及以上。仅年龄似乎就是影响治疗选择的一个主要因素，并且如果获得组织学确诊，更有可能接受治疗。需要对差异原因进行进一步详细分析。转诊至胸科医生的患者更有可能同时获得组织学确诊和积极治疗。本研究支持这样的观点，即所有诊断为肺癌的患者，无论年龄或病情如何，都应由认可的胸科医生进行评估。
