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Initial treatment of early-stage small-sized non-small cell lung cancer for octogenarians: a population-based study

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Abstract

The objectives of this study is to figure out the appropriate initial treatment and criteria for clinical decision for early-stage small-sized non-small cell lung cancer (NSCLC) among octogenarians. Elderly patients (≥80 years) with stage I NSCLC (<3 cm) were identified between 2004 and 2015 in the Surveillance, Epidemiology, and End Results database. Patients were divided into four cohorts regarding treatment modalities, and overall survival and cancer-specific survival were evaluated via Kaplan–Meier analysis and Cox proportional hazard model. The propensity score matching method was introduced in the subgroup analysis stratified by four clinical characteristics to identify the preferable treatment. A total of 7861 patients were included with a median overall survival of 43 months (range 1–155 months). In younger patients (80–85 years), lobectomy was superior in improving the survival (versus segmentectomy, HR = 0.68, 95%CI 0.55–0.84; versus wedge resection, HR = 0.77; 95%CI 0.67–0.88). While in those over 85 years, lobectomy was superior to wedge resection (HR = 0.72; 95%CI 0.53–0.98), and all other treatments were comparable. As stratified by T stage in those over 85 years, lobectomy was superior to wedge resection (P = 0.023) for T1 disease, and the four treatments were all comparable in overall survival for T2 disease. In conclusions, the favored treatment of early stage NSCLC for octogenarians may be evaluated by age and T stage. Lobectomy might be preferred in patients between 80 and 85 years whenever possible. Among those over 85 years, radiotherapy might lead to a comparable prognosis and could be recommended as the prior treatment, while should surgery be recommended, lobectomy might be preferred for T1 disease and wedge resection for T2 disease.

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Author notes

  1. Weijia Huang and Han-Yu Deng have contributed equally to this work.

Authors and Affiliations

  1. Lung Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, People’s Republic of China

    Weijia Huang, Han-Yu Deng, Kai Xu & Qinghua Zhou

  2. West China School of Medicine, Sichuan University, Chengdu, People’s Republic of China

    Kai Xu, Ming-Ying Lin, Peiwei Li & Chi Yuan

Authors
  1. Weijia Huang
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  2. Han-Yu Deng
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  3. Kai Xu
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  5. Peiwei Li
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  6. Chi Yuan
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  7. Qinghua Zhou
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Contributions

WH and HD contributed to the conception of the study and drafting of the manuscript and took full responsibility for the content, including the data and analysis. WH, KX, ML, and PL contributed to the data extraction. WH, HD, ML, and CY contributed to the statistical analysis. WH, HD, and QZ contributed to the revision of the manuscript. All authors have read and approved the manuscript.

Corresponding author

Correspondence to Qinghua Zhou.

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Conflict of interest

The authors declare no conflict of interest.

Funding

This work was supported by the Department of Science and Technology of Sichuan Province (2022JDKP0009).

Research involving human participants and/or animals and Informed consent

Our study was approved by the Institutional Review Board of West China Hospital, Sichuan University, and since our study was analyzed anonymously, the Ethics Committee of West China Hospital, Sichuan University, waived the need for informed consent.

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Huang, W., Deng, HY., Xu, K. et al. Initial treatment of early-stage small-sized non-small cell lung cancer for octogenarians: a population-based study. Updates Surg 74, 1461–1470 (2022). https://doi.org/10.1007/s13304-022-01281-x

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  • DOI: https://doi.org/10.1007/s13304-022-01281-x

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