Risk of Recurrence of Resected Stage I Non-small Cell Lung Cancer in Elderly Patients as Compared with Younger Patients
Risk of Recurrence of Resected Stage I Non-small Cell Lung Cancer in Elderly Patients as Compared with Younger Patients
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DOI：
10.1097/jto.0b013e3181b6bc1b
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发表时间：
2009-11-01
影响因子：
20.4
通讯作者：
Govindan, Ramaswamy
中科院分区：
文献类型：
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作者：
Goodgame, Boone;Viswanathan, Avinash;Govindan, Ramaswamy
目的：所有非小细胞肺癌(NSCLC)患者中有一半在确诊时年龄在70岁以上。手术是适合患有早期疾病的老年患者的一种选择，但手术切除后的疾病复发率没有得到很好的描述。我们报告了老年(170岁或以上)非小细胞肺癌患者手术切除后的预后。患者和方法：我们对1990年至2000年在华盛顿大学医学院-阿尔文·J·西特曼癌症中心手术切除后被诊断为I期非小细胞肺癌的患者进行了回顾性研究。收集了人口统计学、病理学、治疗和随访数据。采用Kaplan-Meier法计算复发率和总生存率。结果：在715例I期非小细胞肺癌患者中，286例确诊时年龄大于或等于70岁。在这一老年队列中，年龄中位数为74岁(范围为70-89岁)，其中140人为女性(49%)。237名患者(83%)接受了肺叶切除术，43名患者(15%)接受了楔形或节段性切除，6名患者(2%)接受了全肺切除术。老年组和年轻组的临床和病理特征在统计学上没有差异，只是与年轻组相比，老年患者更有可能是白人(90%对80%，p=0.0003)，而吸烟者更少(88%对95%，p=0.019)。中位随访期为4.6年，总的5年生存率为52%，5年复发率为24%。相比之下，70岁以下患者的5年生存率为67%(p<；0.001)，5年复发率为24%。结论：虽然老年患者的总体生存状况较差，但术后估计的疾病复发率是相同的。
Purpose: Half of all patients with non-small cell lung cancer (NSCLC) are 70 years or older at the time of diagnosis. Surgery is an option for fit elderly patients with early stage disease, but rates of disease recurrence after surgical resection arc not well described. We report the outcomes in elderly patients (170 years or older) with stage I NSCLC after surgical resection.Patients and Methods: We conducted a retrospective study of patients diagnosed with stage I NSCLC after surgical resection at Washington University School of Medicine-Alvin J. Siteman Cancer Center from 1990 to 2000. Demographic, pathologic, treatment, and follow-up data were collected. Recurrence rates and overall survival were calculated by the Kaplan-Meier method. Multivariate Cox proportional hazards models were used to detect associations between potential prognostic factors and survival and recurrence.Results: Of the 715 patients with stage I NSCLC, 286 were 70 years or older at diagnosis. In this elderly cohort, the median age was 74 years (range, 70-89 years) and 140 of them were women (49%). Lobectomy was performed in 237 patients (83%) whereas 43 patients (15%) had a wedge or segmental resection, and six patients (2%) underwent pneumonectomy. Clinical and pathologic characteristics were not statistically different between the elderly and younger cohorts, with the exception that older patients were more likely to be white (90% versus 80%, p = 0.0003) and less likely to be smokers (88% versus 95%, p = 0.019) compared with the Younger cohort. With a median follow-up of 4.6 years, the overall 5-year survival rate was 52% with a 5-year recurrence rate of 24%. in comparison, the patients younger than 70 years had a 5-year survival rate of 67% (p < 0.001) and a 5-year recurrence rate of 24%.Conclusions: Although overall survival was worse in elderly patients, estimated disease recurrence rates after resection were identical.