Peri- and postoperative morbidity and mortality in older patients with non-small cell lung cancer: a matched-pair study.

Humans Carcinoma, Non-Small-Cell Lung / surgery Male Lung Neoplasms / surgery Female Aged Postoperative Complications / epidemiology Survival Rate Middle Aged Matched-Pair Analysis Prognosis Age Factors Aged, 80 and over Length of Stay / statistics & numerical data Follow-Up Studies Risk Factors Pneumonectomy / mortality Retrospective Studies Neoplasm Staging Morbidity Carcinoma, Squamous Cell / surgery

Journal

World journal of surgical oncology
ISSN: 1477-7819
Titre abrégé: World J Surg Oncol
Pays: England
ID NLM: 101170544

Informations de publication

Date de publication:
08 Aug 2024
Historique:
received: 20 03 2024
accepted: 17 07 2024
medline: 9 8 2024
pubmed: 9 8 2024
entrez: 8 8 2024
Statut: epublish

Résumé

Reports from case series suggest that operative outcomes are comparable amongst different age groups following surgery with curative intent for non-small cell lung cancer (NSCLC). The purpose of this study was to compare morbidity and mortality after NSCLC surgery in older patients (≥ 75 years) versus younger patients (< 75 years) and identify independent predictive risk factors. We identified 2015 patients with postoperative stages IA to IIIA according to AJCC/UICC 7th edition who had undergone NSCLC surgery with curative intent at a single specialized lung cancer center from January 2010 to December 2015. A matched-pair analysis was performed on 227 older patients and corresponding 227 younger patients. Short-term surgical outcomes were postoperative morbidity, length of hospital stay, 30-day and 90-day mortality. Long-term operative outcomes were disease-free and overall survival. 454 patients were included in the matched-pair analysis. 36% of younger patients developed postoperative complications versus 42% in older patients (p = 0.163). Age was not significantly associated with the occurrence of postoperative complications. Median length of hospital stay was 14 days in older patients and 13 days in younger patients (p = 0.185). 90-day mortality was 2.2% in younger patients compared to 4% in older patients (p = 0.424). In patients aged 75 and older impaired performance status (ECOG ≥ 1) was associated with decreased overall survival (HR = 2.15, CI 1.34-3.46), as were preoperative serum C-reactive protein / albumin ratio ≥ 0.3 (HR = 1.95, CI 1.23-3.11) and elevated preoperative serum creatinine levels ≥ 1.1 mg/dl (HR = 1.84, CI 1.15-2.95). In the younger cohort male sex (HR = 2.26, CI 1.17-4.36), postoperative stage III disease (HR 4.61, CI 2.23-9.54) and preoperative anemia (hemoglobin < 12 g/dl) (HR 2.09, CI 1.10-3.96) were associated with decreased overall survival. Lung resection for NSCLC in older patients is associated with postoperative morbidity and mortality comparable to those of younger patients. In older patients, physical activity, comorbidities and nutritional status are related to survival and should influence the indication for surgery rather than age alone.

Sections du résumé

BACKGROUND BACKGROUND
Reports from case series suggest that operative outcomes are comparable amongst different age groups following surgery with curative intent for non-small cell lung cancer (NSCLC). The purpose of this study was to compare morbidity and mortality after NSCLC surgery in older patients (≥ 75 years) versus younger patients (< 75 years) and identify independent predictive risk factors.
METHODS METHODS
We identified 2015 patients with postoperative stages IA to IIIA according to AJCC/UICC 7th edition who had undergone NSCLC surgery with curative intent at a single specialized lung cancer center from January 2010 to December 2015. A matched-pair analysis was performed on 227 older patients and corresponding 227 younger patients. Short-term surgical outcomes were postoperative morbidity, length of hospital stay, 30-day and 90-day mortality. Long-term operative outcomes were disease-free and overall survival.
RESULTS RESULTS
454 patients were included in the matched-pair analysis. 36% of younger patients developed postoperative complications versus 42% in older patients (p = 0.163). Age was not significantly associated with the occurrence of postoperative complications. Median length of hospital stay was 14 days in older patients and 13 days in younger patients (p = 0.185). 90-day mortality was 2.2% in younger patients compared to 4% in older patients (p = 0.424). In patients aged 75 and older impaired performance status (ECOG ≥ 1) was associated with decreased overall survival (HR = 2.15, CI 1.34-3.46), as were preoperative serum C-reactive protein / albumin ratio ≥ 0.3 (HR = 1.95, CI 1.23-3.11) and elevated preoperative serum creatinine levels ≥ 1.1 mg/dl (HR = 1.84, CI 1.15-2.95). In the younger cohort male sex (HR = 2.26, CI 1.17-4.36), postoperative stage III disease (HR 4.61, CI 2.23-9.54) and preoperative anemia (hemoglobin < 12 g/dl) (HR 2.09, CI 1.10-3.96) were associated with decreased overall survival.
CONCLUSIONS CONCLUSIONS
Lung resection for NSCLC in older patients is associated with postoperative morbidity and mortality comparable to those of younger patients. In older patients, physical activity, comorbidities and nutritional status are related to survival and should influence the indication for surgery rather than age alone.

Identifiants

DOI: 10.1186/s12957-024-03491-6 PMID: 39118130
pubmed: 39118130
doi: 10.1186/s12957-024-03491-6
pii: 10.1186/s12957-024-03491-6
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

213

Informations de copyright

© 2024. The Author(s).

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Auteurs

Seyer Safi (S)

Division of Thoracic Surgery, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany.

Maximilian Robert Gysan (MR)

Department of Thoracic Surgery, Heidelberg University Hospital, Thoraxklinik, Heidelberg, Germany.
Division of Pulmonology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.

Dorothea Weber (D)

Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.

Rouven Behnisch (R)

Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany.

Thomas Muley (T)

Translational Lung Research Center Heidelberg (TLRCH), Member of the German Center for Lung Research (DZL), Heidelberg, Germany.
Translational Research Unit, Heidelberg University, Thoraxklinik, Heidelberg, Germany.

Michael Allgäuer (M)

Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany.

Hauke Winter (H)

Department of Thoracic Surgery, Heidelberg University Hospital, Thoraxklinik, Heidelberg, Germany.

Hans Hoffmann (H)

Division of Thoracic Surgery, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany.

Martin Eichhorn (M)

Department of Thoracic Surgery, Heidelberg University Hospital, Thoraxklinik, Heidelberg, Germany. martin.eichhorn@med.uni-heidelberg.de.

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questionsmedicales.fr › Maladies de l'appareil respiratoire › Tumeurs de l'appareil respiratoire › Tumeurs du poumon › Tumeurs des bronches › Carcinome bronchogénique › Carcinome pulmonaire non à petites cellules › Peri- and postoperative morbidity and...
questionsmedicales.fr › Maladies de l'appareil respiratoire › Tumeurs de l'appareil respiratoire › Tumeurs du poumon › Peri- and postoperative morbidity and...
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