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B. Park



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    P3.07 - Poster Session 3 - Surgery (ID 193)

    • Event: WCLC 2013
    • Type: Poster Session
    • Track: Surgery
    • Presentations: 1
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      P3.07-012 - Pulmonary Resection for Stage I Non-Small Cell Lung Cancer in Elderly Patients (ID 1282)

      09:30 - 09:30  |  Author(s): B. Park

      • Abstract

      Background
      With the increase in life expectancy, surgical treatment of non-small cell lung cancer (NSCLC) in elderly patients became more frequent. The aim of this study is to evaluate the risk factors for short and long-term outcomes after pulmonary resection in the elderly patients with stage I NSCLC.

      Methods
      From October 1994 to December 2011, the patients who were surgically treated with curative intent and pathologically diagnosed as stage I NSCLC were included. The patients were divided into two groups; elderly group (≥70 years) and younger group (<70 years). Comorbidity and surgical factors were analyzed for thirty-day mortality, hospital stay and overall survival in both groups.

      Results

      The Risk factors for short and long term outcome after pulmonary resection in elderly patients with stage I NSCLC
      Risk factor 30-day mortality (Pearson’s Chi-Square Test) Hospital stay (Linear Regression Model) 5-year survival (Cox Hazard Model)
      HR (95% CI) p-value HR (95% CI) p-value HR (95% CI) p-value
      DLCO less than 70% 12.9 (1.8-93.6) 0.001 5.0 (2.7-7.3) < 0.001 3.4 (1.5-8.0) 0.004
      FEV~1~/FVC less than 70% NS 2.5 (0.8-4.3) 0.005 NS
      Open thoracotomy NS 3.6 (2.3-4.8) < 0.001 NS
      Pulmonary tuberculosis NS NS 3.3 (1.5-7.5) 0.004
      Interstitial pulmonary fibrosis NS NS 5.0 (1.4-18.0) 0.015
      Creatinine higher than 1.5mg/dL NS NS 5.7 (1.3-25.3) 0.022
      Extensive resection NS NS 4.4 (1.4-14.0) 0.012
      Total 1,340 patients were enrolled and 285 patients (21.3%) were classified as the elderly group and 1,055 patients (78.7%) as the younger group. The thirty-day mortality was 8 of 1,340 patients (0.6%) and all of the patients were elderly. The only independent factor for thirty-day mortality in elderly group was diffusing capacity for carbon monoxide (DLCO) less than 70% of predicted (hazard ratio, 12.9; p = 0.001). The elderly group had significantly longer hospital stay (11.2 12.2 vs. 8.0 6.7 days, p < 0.001). Open thoracotomy (p < 0.001), DLCO less than 70% of predicted (p < 0.001) and percentage of one second forced expiratory volume over forced vital capacity (FEV~1~/FVC) less than 70% (p = 0.005) were significantly associated with longer hospital stay. In-hospital complication rate in elderly patients was also significantly higher (47.7 vs. 26.9%, p < 0.001). 5-year overall survival rates were 91.1% in the younger group and 66.2% in the elderly group. In the elderly group, previous history of tuberculosis (p = 0.004) and interstitial pulmonary fibrosis (IPF; p = 0.015), DLCO less than 70% of predicted (p = 0.004), preoperative creatinine higher than 1.5 mg/dL (p = 0.022), and more extensive pulmonary resection (p = 0.012) were the independent risk factors for overall survival. On the other hand, previous history of IPF (p < 0.001) and pathologic stage IB over IA (p < 0.001) were the independent risk factors in the younger group.

      Conclusion
      Pulmonary resection for the elderly patient requires caution, particularly in case of low diffusing capacity (DLCO < 70%) or airflow limitation (FEV1/FVC < 70%).