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Benefit of Adjuvant Chemotherapy After Resection of Stage II (T1-2N1M0) Non-Small Cell Lung Cancer in Elderly Patients

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

We evaluated the use and efficacy of adjuvant chemotherapy after resection of T1-2N1M0 non-small cell lung cancer (NSCLC) in elderly patients.

Methods

Factors associated with the use of adjuvant chemotherapy in patients older than 65 years of age who underwent surgical resection of T1-2N1M0 NSCLC without induction chemotherapy or radiation in the Surveillance, Epidemiology, and End Results-Medicare database from 1992 to 2006 were assessed using a multivariable logistic regression model that included treatment, patient, tumor, and census tract characteristics. Overall survival (OS) was analyzed using the Kaplan–Meier approach and inverse probability weight-adjusted Cox proportional hazard models.

Results

Overall, 2,781 patients who underwent surgical resection as the initial treatment for T1-2N1M0 NSCLC and survived at least 31 days after surgery were identified, with adjuvant chemotherapy given to 784 patients (28.2 %). Factors that predicted adjuvant chemotherapy use were younger age and higher T status. The 5-year OS was significantly better for patients who received adjuvant chemotherapy compared with patients not given adjuvant chemotherapy: 35.8 % (95 % confidence interval [CI] 31.9–39.6) vs. 28.0 % (95 % CI 25.9–30.0) (p = 0.008). In the inverse probability weight-adjusted Cox proportional hazard regression model, adjuvant chemotherapy use predicted significantly improved survival (hazard ratio 0.84; 95 % CI 0.76–0.92; p = 0.0002).

Conclusions

Adjuvant chemotherapy after resection of T1-2N1M0 NSCLC is associated with significantly improved survival in patients older than 65 years. These data can be used to provide elderly patients with realistic expectations of the potential benefits when considering adjuvant chemotherapy in this setting.

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Acknowledgment

This work was supported by the National Institute of Health funded Cardiothoracic Surgical Trials Network (5U01HL088953-05: MFB) and by the National Institute on Aging (1R21AG045245-01: MFB, IA).

Disclosure

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Authors and Affiliations

  1. Department of Surgery, Duke University, Durham, NC, USA

    Mark F. Berry MD, Brooke K. Coleman MD, Mathias Worni MD, MHS & Thomas A. D’Amico MD

  2. Duke Clinical Research Institute, Duke University, Durham, NC, USA

    Lesley H. Curtis PhD

  3. Department of Medicine, Duke University, Durham, NC, USA

    Lesley H. Curtis PhD

  4. Center for Population Health and Aging, Duke University, Durham, NC, USA

    Igor Akushevich PhD

  5. Department of Cardiothoracic Surgery Falk Cardiovascular Research Center, Stanford University, Stanford, CA, USA

    Mark F. Berry MD

Authors
  1. Mark F. Berry MD
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  2. Brooke K. Coleman MD
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  3. Lesley H. Curtis PhD
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  4. Mathias Worni MD, MHS
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  5. Thomas A. D’Amico MD
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  6. Igor Akushevich PhD
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Correspondence to Mark F. Berry MD.

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Berry, M.F., Coleman, B.K., Curtis, L.H. et al. Benefit of Adjuvant Chemotherapy After Resection of Stage II (T1-2N1M0) Non-Small Cell Lung Cancer in Elderly Patients. Ann Surg Oncol 22, 642–648 (2015). https://doi.org/10.1245/s10434-014-4056-0

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  • DOI: https://doi.org/10.1245/s10434-014-4056-0

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