Treatment of the Elderly When Cure is the Goal The Influence of Age on Treatment Selection and Efficacy for Stage III Non-small Cell Lung Cancer
Treatment of the Elderly When Cure is the Goal The Influence of Age on Treatment Selection and Efficacy for Stage III Non-small Cell Lung Cancer
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DOI：
10.1097/jto.0b013e31820b8b9b
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发表时间：
2011-03-01
影响因子：
20.4
通讯作者：
Shepherd, Frances A.
中科院分区：
文献类型：
--
作者：
Coate, Linda E.;Massey, Christine;Shepherd, Frances A.
背景：老年III期非小细胞肺癌患者的治疗存在争议。有限的数据存在，老年人在临床试验中代表性不足。方法：伦理批准后，我们进行了回顾性分析，1372年在我们的机构在1997年至2007年期间治疗的III期非小细胞肺癌患者。排除了仅在术后发现的恶性积液和显微镜下N2的患者，剩下740例患者按治疗计划分类：姑息性（姑息性化疗或放疗[ 40戈伊+/-化疗）;或外科多模式（化疗、放疗和手术）。人口统计学、治疗、毒性和生存率按年龄进行分析，0至65岁，n = 384; 66至75岁，n = 256; 76+岁，n = 100，并使用对数秩、单变量和多变量统计检验进行比较。年龄大于65岁的患者更有可能表现不佳（p < 0.0001）、多种合并症（p < 0.0001）和仅接受姑息治疗（p < 0.0001）。接受非手术双模式治疗或包括手术在内的三模式治疗的老年和年轻患者的3/4级毒性发生率相似（0-65岁，39%; 66-75岁，43%; 76岁以上，5%; p = 0.18）和中毒性死亡（0-65岁，4%; 66-75岁，4%; 76岁以上，0%; p = 0.76）。随着年龄的增长，生存率更差（p < 0.0001），可能是由于老年人更多地使用姑息治疗。当生存分析的患者治疗的治愈意图，有年龄组之间的非手术（p = 0.32）或手术（p = 0.53）therapy.Conclusion：在选择合适的老年患者，综合治疗是可以忍受的，并与生存相似的年轻患者。
Background: Treatment of elderly patients with stage III NSCLC is controversial. Limited data exist, as the elderly are underrepresented in clinical trials.Methods: After ethics approval, we performed a retrospective review of 1372 stage III NSCLC patients treated at our institution during the period 1997-2007. Patients with malignant effusions and microscopic N2 discovered only postoperatively were excluded, leaving 740 who were classified by treatment plan: palliative (palliative chemotherapy or radiation [ 40 Gy radiation +/- chemotherapy); or surgical multimodality (chemotherapy, radiation, and surgery). Demographics, treatment, toxicity, and survival were analyzed by age, 0 to 65 years, n = 384; 66 to 75 years, n = 256; 76+ years, n = 100, and compared using log-rank, univariate, and multivariate statistical tests.Results: Patients older than 65 years were more likely to have poor performance status (p < 0.0001), multiple comorbidities (p < 0.0001), and to receive palliative therapy only (p < 0.0001). Older and younger patients treated with curative intent with nonsurgical bimodality therapy or trimodality therapy including surgery had similar rates of grade 3/4 toxicity (0-65 years, 39%; 66-75 years, 43%; 76+ years, 5%; p = 0.18) and toxic death (0-65 years, 4%; 66-75 years, 4%; 76+ years, 0%; p = 0.76). Survival was worse with increasing age (p < 0.0001), likely due to greater use of palliative treatment in the elderly. When survival was analyzed for patients treated with curative intent, there was no difference between age groups for nonsurgical (p = 0.32) or surgical (p = 0.53) therapy.Conclusion: In select fit elderly patients, combined modality therapy is tolerable and is associated with survival similar to that of younger patients.