The influence of comorbidity on the postoperative survival in elderly (≥ 75 years old) with lung cancer
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We conducted a multi-institutional prospective observational study of elderly patients (≥ 75 years-old) with resected non-small cell lung cancer. In this report, we have followed the cohorts for 2 years after surgery and examined both the influence of preoperative comorbidity [Adult Comorbidity Evaluation-27 (ACE-27) index] on the postoperative survival and the change in the Karnofsky Performance Status (KPS).
From March 2014 to April 2015, 264 patients were prospectively registered from 22 hospitals affiliated with the National Hospital Organization. The mean age at the time of surgery was 79.3 years (range 75–90 years), and 41% of the patients were ≥ 80 years of age. A total of 26% underwent sublobar resection. The study endpoints were the postoperative overall survival (OS), its prognostic factors, and the changes in the postoperative KPS.
The 2-year OS was 85.3% (95% confidence interval 80.4–89.1%). Male gender, age ≥ 80, a smoking history, grade 2 of ACE-27, and an advanced disease stage were significantly poor prognostic factors for the OS in the univariate risk analysis. The multivariate analysis showed that male gender, age ≥ 80, an advanced disease stage and sublobar resection were significantly poor prognostic factors for the OS. In comparison with the preoperative KPS, no marked decline was observed in the postoperative chorological change of KPS.
In the surgical treatment of elderly patients, the comorbidity as assessed by the ACE-27 index might affect the postoperative survival, and therefore should be taken into accounts in the preoperative evaluation of the surgical indications.
KeywordsNon-small cell lung cancer Surgery Karnofsky Performance Status Adult Comorbidity Evaluation-27 Postoperative survival
This study was funded by the National Hospital Organization (Tokyo, Japan). The authors declare no conflicts of interest in association with the present study. This manuscript was reviewed by all authors. The corresponding author had full access to the study data and takes full responsibility for the final decision to submit the manuscript. We thank the patients, all of the investigators who participated in the study, and the Data Center at the Kyushu Cancer Center. This manuscript was edited in English by Mr. Brian Quinn, the Official English Medical Editor of the Japan Surgical Society.
This work was supported by the National Hospital Organization (Tokyo, Japan).
Compliance with ethical standards
Conflict of interest
The authors have declared that no conflict of interest exists.
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