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The influence of comorbidity on the postoperative survival in elderly (≥ 75 years old) with lung cancer

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Abstract

Objectives

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).

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgements

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.

Funding

This work was supported by the National Hospital Organization (Tokyo, Japan).

Author information

Authors and Affiliations

  1. Department of General Thoracic Surgery, National Hospital Organization Beppu Medical Center, 1473 Uchikamado, Beppu, 874-0011, Japan

    Tokujiro Yano & Seiichi Fukuyama

  2. Cancer Biostatistics Laboratory, Clinical Research Institute, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan

    Mototsugu Shimokawa

  3. Department of Chest Surgery, National Hospital Organization Shibukawa Medical Center, Shibukawa, Japan

    Osamu Kawashima

  4. Department of Thoracic Oncology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan

    Mitsuhiro Takenoyama

  5. Department of Chest Surgery, National Hospital Organization Kure Medical Center and Chugoku Cancer Center, Kure, Japan

    Yoshinori Yamashita

  6. Department of Thoracic Surgery, National Hospital Organization Tokyo National Hospital, Tokyo, Japan

    Takeshi Fukami

  7. Department of General Thoracic Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan

    Tsuyoshi Ueno

  8. Department of General Thoracic Surgery, National Hospital Organization Obihiro Hospital, Obihiro, Japan

    Eiji Yatsuyanagi

Authors
  1. Tokujiro Yano
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  2. Mototsugu Shimokawa
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  3. Osamu Kawashima
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  4. Mitsuhiro Takenoyama
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  5. Yoshinori Yamashita
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  6. Takeshi Fukami
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  7. Tsuyoshi Ueno
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  8. Eiji Yatsuyanagi
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  9. Seiichi Fukuyama
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Consortia

For the National Hospital Organization Network Collaborative Research—Thoracic Oncology Group

Corresponding author

Correspondence to Tokujiro Yano.

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Conflict of interest

The authors have declared that no conflict of interest exists.

Additional information

Clinical Trial Registration ID: UMIN000021904.

Appendix

Appendix

The participating hospitals that are affiliated with the National Hospital Organization in Japan as follows: Shibukawa Medical Center, Kyushu Medical Center, Hokkaido Cancer Center, Nagasaki Medical Center, Kyushu Cancer Center, Kure Medical Center, Obihiro National Hospital, Shikoku Cancer Center, Tokyo National Hospital, Mito Medical Center, Beppu Medical Center, Yokohama Medical Center, Higashihiroshima Medical Center, Takasaki General Medical Center, Saitama National Hospital, Ureshino Medical Center, Nagara Medical Center, Nishi-Niigata Chuo National Hospital, Asahikawa Medical Center, Tokyo Medical Center, Osaka Medical Center, Kochi National Hospital.

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Yano, T., Shimokawa, M., Kawashima, O. et al. The influence of comorbidity on the postoperative survival in elderly (≥ 75 years old) with lung cancer. Gen Thorac Cardiovasc Surg 66, 344–350 (2018). https://doi.org/10.1007/s11748-018-0919-9

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  • DOI: https://doi.org/10.1007/s11748-018-0919-9

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