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Competing Risk Analysis in Lung Cancer Patients Over 80 Years Old Undergoing Surgery

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Abstract

Background

This study aimed to analyze cause-specific mortality in lung cancer patients over 80 years old undergoing surgery.

Methods

This retrospective, multi-institutional analysis included patients aged ≥ 80 years who underwent radical surgery for primary lung cancer from January 1998 to December 2015. Preoperative clinical data, surgical results, survival, and cause of death were evaluated. Competing risk analysis for cause-specific mortality was performed.

Results

Of the 337 patients (median age 82 years) enrolled and analyzed, 68.1% were male. There were 52 and 44 cancer-specific and non-cancer-specific deaths, respectively. On competing risk regression analysis, non-cancer-specific deaths were significantly associated with male sex (hazard ratio [HR]: 3.06, 95% confidence interval [CI]: 1.02–9.12, p = 0.046), coronary artery disease (HR: 2.49, 95% CI: 2.49 [1.14–5.47], p = 0.02), interstitial pneumonia (HR: 3.58, 95% CI: 1.73–7.40, p < 0.001), and pathological stage III (HR: 3.83, 95% CI: 1.44–10.13, p = 0.007). In contrast, cancer-specific deaths were significantly associated with limited resection (HR: 1.99, 95% CI: 1.02–3.89, p = 0.04) and pathological stage III (HR: 3.13, 95% CI: 1.44–6.80, p = 0.004). The 5-year cumulative incidences of lung cancer-specific and non-cancer-specific deaths were 18.0% and 15.9%, respectively.

Conclusions

Prognostic factors for non-cancer-specific death were different from those of cancer-specific death, except for pathological stage. Each prognostic factor should be considered when deciding surgical indication and procedure and monitoring for pulmonary events during outpatient follow-up.

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Acknowledgements

We are deeply grateful to Editage for English proofreading.

Author information

Authors and Affiliations

  1. Department of Thoracic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, 35-2 Sakaecho Itabashi-ku, Tokyo, 173-0015, Japan

    Haruaki Hino

  2. Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan

    Takahiro Karasaki, Junji Ichinose, Mitsuaki Kawashima & Jun Nakajima

  3. Department of Thoracic Surgery, Asahi General Hospital, 1326 I Asahi-shi, Chiba, 289-2511, Japan

    Yukihiro Yoshida

  4. Department of Thoracic Surgery, National Hospital Organization Tokyo National Hospital, 3-1-1 Takeoka Kiyose-shi, Tokyo, 204-8585, Japan

    Takeshi Fukami

  5. Department of Thoracic Surgery, Chigasaki Municipal Hospital, 5-15-1 Honson Chigasaki-shi, Kanagawa, 253-0042, Japan

    Atsushi Sano

  6. Department of Thoracic Surgery, JR Tokyo General Hospital, 2-1-3 Yoyogi Shibuya-ku, Tokyo, 151-8528, Japan

    Makoto Tanaka

  7. Department of Thoracic Surgery, Japanese Red Cross Medical Center, 4-1-22 Hiroo Shibuya-ku, Tokyo, 150-8935, Japan

    Yoshiaki Furuhata

  8. Department of Biostatistics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan

    Kosuke Kashiwabara

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  1. Haruaki Hino
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  2. Takahiro Karasaki
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  4. Takeshi Fukami
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  6. Makoto Tanaka
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  8. Kosuke Kashiwabara
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  9. Junji Ichinose
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  10. Mitsuaki Kawashima
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  11. Jun Nakajima
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Correspondence to Jun Nakajima.

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268_2019_4982_MOESM1_ESM.pdf

Cumulative incidence of death curve stratified by lung cancer-specific and non-cancer-specific deaths within 30 months after surgery (PDF 33 kb)

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Hino, H., Karasaki, T., Yoshida, Y. et al. Competing Risk Analysis in Lung Cancer Patients Over 80 Years Old Undergoing Surgery. World J Surg 43, 1857–1866 (2019). https://doi.org/10.1007/s00268-019-04982-4

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  • DOI: https://doi.org/10.1007/s00268-019-04982-4

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