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Survival in the elderly after pneumonectomy for early-stage non-small cell lung cancer: a comparison with nonoperative management.

Publication ,  Journal Article
Speicher, PJ; Ganapathi, AM; Englum, BR; Onaitis, MW; D'Amico, TA; Berry, MF
Published in: J Am Coll Surg
March 2014

BACKGROUND: Short-term outcomes of morbidity, mortality, and quality of life after pneumonectomy worsen with increasing age. The impact of age on long-term outcomes has not been well described. The purpose of this study was to quantify the impact of patient age on long-term survival after pneumonectomy for early-stage non-small cell lung cancer. STUDY DESIGN: Overall survival (OS) of patients who had a pneumonectomy for stage I to II non-small cell lung cancer in the Surveillance Epidemiology and End Results program registry from 1988 through 2010 was evaluated using multivariable and propensity score adjusted Cox proportional hazard models. Age was stratified as younger than 50 years, 50 to 69 years, 70 to 79 years, and 80 years and older. Pneumonectomy patients' OS was compared with matched patients who refused surgery and underwent radiation therapy (RT). RESULTS: Pneumonectomies comprised 10.8% of non-small cell lung cancer resections in 1988, but only 2.9% in 2010. Overall, 5-year OS of 5,701 pneumonectomy patients was 49.8% (95% CI, 45.3-54.8%) for patients younger than 50 years, 40.5% (95% CI, 38.8-42.2%) for patients 50 to 69 years, 28.9% (95% CI, 26.6-31.5%) for patients 70 to 79 years, and 18.8% (95% CI, 14.2-24.8%) for patients 80 and older (p < 0.001). Increasing patient age was the most important predictor of worse OS (hazard ratio = 1.34 per decade; p < 0.001). For patients younger than 70 years, 5-year OS was 46.3% (95% CI, 36.2-59.2%) after pneumonectomy vs 18.4% (95% CI, 11.9-28.3%) for matched RT patients (p < 0.001). In matched groups of patients 70 years and older, 5-year OS for pneumonectomy was 25.8% (95% CI, 20.8-32.0%) vs 12.2% for RT (95% CI, 8.6-17.4%; p = 0.02). CONCLUSIONS: Survival after pneumonectomy for stage I to II non-small cell lung cancer decreases steadily with patient age. The incremental benefit of pneumonectomy vs RT in matched patients is less in patients older than 70 years than in younger patients, although outcomes with pneumonectomy are superior to RT in all age groups. Patients should not be denied pneumonectomy based on age alone, but careful patient selection in elderly patients is essential to optimize survival.

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Published In

J Am Coll Surg

DOI

EISSN

1879-1190

Publication Date

March 2014

Volume

218

Issue

3

Start / End Page

439 / 449

Location

United States

Related Subject Headings

  • Survival Analysis
  • Surgery
  • Quality of Life
  • Propensity Score
  • Pneumonectomy
  • Neoplasm Staging
  • Middle Aged
  • Male
  • Lung Neoplasms
  • Humans
 

Citation

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Speicher, P. J., Ganapathi, A. M., Englum, B. R., Onaitis, M. W., D’Amico, T. A., & Berry, M. F. (2014). Survival in the elderly after pneumonectomy for early-stage non-small cell lung cancer: a comparison with nonoperative management. J Am Coll Surg, 218(3), 439–449. https://doi.org/10.1016/j.jamcollsurg.2013.12.005
Speicher, Paul J., Asvin M. Ganapathi, Brian R. Englum, Mark W. Onaitis, Thomas A. D’Amico, and Mark F. Berry. “Survival in the elderly after pneumonectomy for early-stage non-small cell lung cancer: a comparison with nonoperative management.J Am Coll Surg 218, no. 3 (March 2014): 439–49. https://doi.org/10.1016/j.jamcollsurg.2013.12.005.
Speicher PJ, Ganapathi AM, Englum BR, Onaitis MW, D’Amico TA, Berry MF. Survival in the elderly after pneumonectomy for early-stage non-small cell lung cancer: a comparison with nonoperative management. J Am Coll Surg. 2014 Mar;218(3):439–49.
Speicher, Paul J., et al. “Survival in the elderly after pneumonectomy for early-stage non-small cell lung cancer: a comparison with nonoperative management.J Am Coll Surg, vol. 218, no. 3, Mar. 2014, pp. 439–49. Pubmed, doi:10.1016/j.jamcollsurg.2013.12.005.
Speicher PJ, Ganapathi AM, Englum BR, Onaitis MW, D’Amico TA, Berry MF. Survival in the elderly after pneumonectomy for early-stage non-small cell lung cancer: a comparison with nonoperative management. J Am Coll Surg. 2014 Mar;218(3):439–449.
Journal cover image

Published In

J Am Coll Surg

DOI

EISSN

1879-1190

Publication Date

March 2014

Volume

218

Issue

3

Start / End Page

439 / 449

Location

United States

Related Subject Headings

  • Survival Analysis
  • Surgery
  • Quality of Life
  • Propensity Score
  • Pneumonectomy
  • Neoplasm Staging
  • Middle Aged
  • Male
  • Lung Neoplasms
  • Humans