A prospective observational study of postoperative adjuvant chemotherapy for non-small cell lung cancer in elderly patients (≥ 75 years).
Elderly patients
Karnofsky performance status
Non-small cell lung cancer
Postoperative adjuvant chemotherapy
Surgery
Journal
International journal of clinical oncology
ISSN: 1437-7772
Titre abrégé: Int J Clin Oncol
Pays: Japan
ID NLM: 9616295
Informations de publication
Date de publication:
May 2022
May 2022
Historique:
received:
29
11
2021
accepted:
14
02
2022
pubmed:
26
2
2022
medline:
26
4
2022
entrez:
25
2
2022
Statut:
ppublish
Résumé
To examine the effects of postoperative adjuvant chemotherapy for elderly (≥ 75 years of age) patients with completely resected non-small cell lung cancer (NSCLC), we conducted a multi-institutional and prospective observational study. Patients were recruited between January 2014 and December 2017, and assigned to two cohort groups based on the patients' choice either to receive postoperative adjuvant chemotherapy (Cohort B) or not (Cohort A). All the patients were observed for 2 years after enrollment. The primary endpoint was the postoperative change of Karnofsky Performance Status (KPS) at 2 years. The secondary endpoints were postoperative recurrence-free survival (RFS) and overall survival (OS) at 2 years, and the completion rate of the adjuvant chemotherapy. Two hundred and seventy-two patients were enrolled (Cohort A, n = 225; Cohort B, n = 47). At any time point after surgery, no marked difference of KPS was observed between Cohort B and Cohort A. The RFS at 2 years was 70.8% (95% confidence interval [CI], 64.3-76.4) in Cohort A and 76.0% (95% CI 60.8-85.9) in Cohort B. The OS at 2 years was 85.9% (95% CI 80.4-89.9) in Cohort A and 89.1% (95% CI 75.8-95.3) in Cohort B. The completion rate of planned chemotherapy was 49.9% (95% CI 34.1-63.9%). The elderly patients were not likely to choose to receive postoperative adjuvant chemotherapy; however, no significant adverse effect on postoperative KPS was identified. Clinical Trial Registration ID: UMIN000020736.
Sections du résumé
BACKGROUND
BACKGROUND
To examine the effects of postoperative adjuvant chemotherapy for elderly (≥ 75 years of age) patients with completely resected non-small cell lung cancer (NSCLC), we conducted a multi-institutional and prospective observational study.
METHODS
METHODS
Patients were recruited between January 2014 and December 2017, and assigned to two cohort groups based on the patients' choice either to receive postoperative adjuvant chemotherapy (Cohort B) or not (Cohort A). All the patients were observed for 2 years after enrollment. The primary endpoint was the postoperative change of Karnofsky Performance Status (KPS) at 2 years. The secondary endpoints were postoperative recurrence-free survival (RFS) and overall survival (OS) at 2 years, and the completion rate of the adjuvant chemotherapy.
RESULTS
RESULTS
Two hundred and seventy-two patients were enrolled (Cohort A, n = 225; Cohort B, n = 47). At any time point after surgery, no marked difference of KPS was observed between Cohort B and Cohort A. The RFS at 2 years was 70.8% (95% confidence interval [CI], 64.3-76.4) in Cohort A and 76.0% (95% CI 60.8-85.9) in Cohort B. The OS at 2 years was 85.9% (95% CI 80.4-89.9) in Cohort A and 89.1% (95% CI 75.8-95.3) in Cohort B. The completion rate of planned chemotherapy was 49.9% (95% CI 34.1-63.9%).
CONCLUSIONS
CONCLUSIONS
The elderly patients were not likely to choose to receive postoperative adjuvant chemotherapy; however, no significant adverse effect on postoperative KPS was identified.
TRIAL REGISTRATION
BACKGROUND
Clinical Trial Registration ID: UMIN000020736.
Identifiants
pubmed: 35212829
doi: 10.1007/s10147-022-02143-7
pii: 10.1007/s10147-022-02143-7
doi:
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
882-888Informations de copyright
© 2022. The Author(s) under exclusive licence to Japan Society of Clinical Oncology.
Références
Brunelli A, Kim AW, Berger KI et al (2013) Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: diagnosis and management of lung cancer, 3rd ed: American college of chest physicians evidence-based clinical practice guidelines. Chest 143(Suppl):166S-190S
doi: 10.1378/chest.12-2395
Brunelli A, Charloux A, Bolliger CT et al (2009) The European Respiratory Society and European Society of Thoracic Surgeons clinical guidelines for evaluating fitness for radical treatment (surgery and chemoradiotherapy) in patients with lung cancer. Eur J Cardiothorac Surg 36:181–184
doi: 10.1016/j.ejcts.2009.04.022
Masuda M, Endo S, Natsugoe S et al (2018) Thoracic and cardiovascular surgery in Japan during 2015. Gen Thorac Cardiovasc Surg 66(10):581–615
doi: 10.1007/s11748-018-0968-0
Goldstraw P, Chansky K, Crowley J et al (2016) The IASLC lung cancer staging project: proposals for revision of the TNM stage groupings in the forthcoming (eighth) edition of the TNM classification for lung cancer. J Thorac Oncol 11:39–51
doi: 10.1016/j.jtho.2015.09.009
Inoue M, Okumura M, Sawabata N et al (2014) Clinicopathological characteristics and surgical results of lung cancer patients aged up to 50 years: the Japanese lung cancer registry study 2004. Lung Cancer 83:246–251
doi: 10.1016/j.lungcan.2013.11.007
Kato H, Ichinose Y, Ohta M et al (2004) Japan lung cancer research group on postsurgical adjuvant chemotherapy. A randomized trial of adjuvant chemotherapy with uracil-tegafur for adenocarcinoma of the lung. N Engl J Med 350:1713–1721
doi: 10.1056/NEJMoa032792
Hamada C, Tanaka F, Ohta M et al (2005) Meta-analysis of postoperative adjuvant chemotherapy with tegafur-uracil in non-small-cell lung cancer. J Clin Oncol 23:4999–5006
doi: 10.1200/JCO.2005.09.017
Pignon JP, Tribodet H, Scagliotti GV et al (2008) Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE collaborative group. J Clin Oncol 26:3552–3559
doi: 10.1200/JCO.2007.13.9030
Arriagada R, Auperin A, Burdett S et al (2010) Adjuvant chemotherapy, with or without postoperative radiotherapy, in operable non-small-cell lung cancer: two meta-analyses of individual patient data. Lancet 375:1267–1277
doi: 10.1016/S0140-6736(10)60059-1
Winton T, Livingston R, Johnson D et al (2005) Vinorelbine plus cisplatin vs observation in resected non-small-cell lung cancer. N Engl J Med 352:2589–2597
doi: 10.1056/NEJMoa043623
Yano T, Yokoyama H, Fukuyama Y et al (1997) The current status of postoperative complications and risk factors after a pulmonary resection for primary lung cancer. A multivariate analysis. Eur J Cardiothorac Surg 11:445–449
doi: 10.1016/S1010-7940(96)01097-4
Umezu H, Miyoshi S, Araki O et al (2012) Efficacy of functional operability algorithm for octogenarians with primary lung cancer. Gen Thorac Cardiovasc Surg 60:36–42
doi: 10.1007/s11748-011-0842-9
Fanucchi O, Ambrogi MC, Dini P et al (2011) Surgical treatment of non-small cell lung cancer in octogenarians. Interact Cardiovasc Thorac Surg 12:749–753
doi: 10.1510/icvts.2010.259002
Port JL, Mirza FM, Lee PC et al (2011) Lobectomy in octogenarians with non-small cell lung cancer: ramifications of increasing life expectancy and the benefits of minimally invasive surgery. Ann Thorac Surg 92:1951–1957
doi: 10.1016/j.athoracsur.2011.06.082
Yano T, Kawashima O, Takeo S et al (2017) A prospective observational study of pulmonary resection for non-small cell lung cancer in patients older than 75 years. Semin Thorac Cardiovasc Surg 29:540–547
doi: 10.1053/j.semtcvs.2017.05.004
Piccirillo JF, Tierney RM, Costas I et al (2004) Prognostic importance of comorbidity in a hospital-based cancer registry. JAMA 291:2441–2447
doi: 10.1001/jama.291.20.2441
Read WL, Tierney RM, Page NC et al (2004) Differential prognostic impact of comorbidity. J Clin Oncol 22:3099–3103
doi: 10.1200/JCO.2004.08.040
Yano T, Shimokawa M, Kawashima O et al (2018) The influence of comorbidity on the postoperative survival in elderly (≥ 75 years old) with lung cancer. Gen Thorac Cardiovasc Surg 66:344–350
doi: 10.1007/s11748-018-0919-9
Okami J, Shintani Y, Okumura M et al (2019) Demographics, safety and quality, and prognostic information in both the seventh and eighth editions of the TNM Classification in 18,973 surgical cases of the japanese joint committee of lung cancer registry database in 2010. J Thorac Oncol 14:212–222
doi: 10.1016/j.jtho.2018.10.002
pubmed: 30316011