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K. Baldvinsson
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P1.07 - Poster Session 1 - Surgery (ID 184)
- Event: WCLC 2013
- Type: Poster Session
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 10/28/2013, 09:30 - 16:30, Exhibit Hall, Ground Level
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P1.07-024 - Surgical outcome of elderly patients with non-small cell lung carcinoma (ID 1965)
09:30 - 09:30 | Author(s): K. Baldvinsson
- Abstract
Background
Elderly patients are increasingly diagnosed and treated for non-small cell lung carcinoma (NSCLC). We studied short- and long-term outcomes following pulmonary resection in elderly (≥75 yrs) patients and compared them to younger patients.Methods
This was a nation-wide study of all patients in Iceland that underwent pulmonary resection for NSCLC between 1991 and 2010. Clinical features, complications and survival were compared between patients older (n=108, 21%) and younger (n=404, 79%) than 75 years.Results
Preoperative lung function and histology were comparable in both groups, however, coronary artery disease was more common in the elderly group, as were sublobar resections (24% vs. 8%, p<0.001). In the elderly group 91% of patients were diagnosed in TNM-stages I+II compared to 75% in younger patients (p<0.001). Mortality within 30 days was similar in both groups (<1%) as was the rate of minor and major complications. Overall survival at 5 years was comparable for both groups (39% vs. 42%, p=0.28) as was cancer specific survival (55 vs. 47%, p=0,64). In multivariate analysis age over 75 years did not significantly influence survival (HR 1.20, CI: 0.87-1.66, p=0.26).Conclusion
Early and late outcomes of pulmonary resections in elderly NSCLC-patients were comparable to younger patients. However, selection of patients could have biased the outcome in favour of the elderly patients with lower stages, and more sublobar resections. Surgery seems to be a valid treatment option for NSCLC in the elderly.
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P2.07 - Poster Session 2 - Surgery (ID 190)
- Event: WCLC 2013
- Type: Poster Session
- Track: Surgery
- Presentations: 1
- Moderators:
- Coordinates: 10/29/2013, 09:30 - 16:30, Exhibit Hall, Ground Level
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P2.07-038 - Elderly patients with non-small cell lung cancer are often not operated on - Results from a population-based study (ID 3070)
09:30 - 09:30 | Author(s): K. Baldvinsson
- Abstract
Background
We have previously reported favorable outcomes in elderly patients treated with surgery for NSCLC. In this study we have evaluated all elderly patients that were diagnosed with NSCLC in Iceland and specifically studied those that were not operated on.Methods
A whole nation study has been conducted that included all patients diagnosed with NSCLC in Iceland between 1991 and 2010 according to the Icelandic Cancer Registry. Data on staging, functional status and survival was obtained from medical records. All tumors were staged clinically (cTNM) and the reasons for exclusion from surgery were registered for elderly patients with cTNM stages IA – IIIA.Results
Of 2263 patients with NSCLC, 735 (32.5%) were defined as elderly. Resection rate for the elderly was 15% compared to 26% for younger patients (p<0.001). Out of 627 elderly patients 55% had localized/regional disease that was considered potentially resectable, and of that group 42% were not operated on. The most common reasons for exclusion from surgery were poor pulmonary function (40%) ECOG-performance status (15%), central tumor location (14%), underlying heart disease (11%) or that the patient rejected treatment (9%).Conclusion
Elderly patients with potentially resectable NSCLC are frequently excluded from surgery due to co-morbid conditions. Their favorable 30-day and long-term survival may reflect bias in selection of lower risk patients.
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P3.19 - Poster Session 3 - Imaging (ID 181)
- Event: WCLC 2013
- Type: Poster Session
- Track: Imaging, Staging & Screening
- Presentations: 1
- Moderators:
- Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level
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P3.19-018 - Incidental detection on computed tomography is an independant prognostic factor of survival in patients operated for non-small cell lung carcinoma (ID 3067)
09:30 - 09:30 | Author(s): K. Baldvinsson
- Abstract
Background
Non-small cell lung carcinomas (NSCLCs) are sometimes detected incidentally on imaging for unrelated causes. We studied the rate of incidental detection and its impact on long-term survival in a nation-wide cohort of patients operated for NSCLC.Methods
This population-based study included all patients who underwent pulmonary resection for NSCLC in Iceland between 1991 and 2010. Demographics and clinicopathological features were compared in patients diagnosed incidentally and those presenting due to symptoms. The data was devided into four 5-year periods to assess trends, and multivariate analysis used to evaluate prognostic factors of cancer-specific survival (CSS), focusing on incidental detection.Results
From a total of 512 patients, 174 (34%) were diagnosed incidentally and this proportion remained unchanged during the study period. Most tumors were detected by chest X-ray (CXR) (26%) or CT (8%), but the proportion of CT diagnoses rose to 15% during the last 5-year period. The incidentally detected tumors were smaller (3.0 vs 4.3 cm, p<0.0001) and were diagnosed at earlier TNM-stages (64 vs. 40% on TNM-stage I, p<0.0001). Furthermore, a higher fraction of the incidentally detected tumors were adenocarcinomas. Five-year CSS for patients with symptoms was 40%, those incidentally detected on CXR 57% and on CT 80% (p<0.001). By multivariate analysis patients detected incidentally on CT had significantly better CSS compared to those diagnosed incidentally by CXR or for patients with symptoms related to NSCLC (HR 0.38, 95% CI 0.16-0.88, p=0.02).Conclusion
A third of surgically treated NSCLC-patients are detected incidentally, and this fraction has not changed for two decades. However the proportion of CT-detected NSCLCs is increasing and these patients seem to have a more favorable survival than patients detected incidentally on CXR or those who present with symptoms.
