Author of

• 12495

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

  • Event: WCLC 2013
  • Type: Poster Session
  • Track: Surgery
  • Presentations: 1
  • Moderators:
  • Coordinates: 10/30/2013, 09:30 - 16:30, Exhibit Hall, Ground Level

  • 12507

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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): G. Lee
    • 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%).