title: Pulmonary resection in octogenarians with stage I nonsmall cell lung cancer: a 22-year experience.
abstract: BACKGROUND
  Recent reports indicate that age is not a contraindication to pulmonary resection for octogenarians with nonsmall cell lung cancer (NSCLC), but other data are lacking. The purpose of this study was to determine outcomes in these patients, particularly short- and long-term survival with stage I disease.
  
  
  METHODS
  A retrospective cohort of 68 octogenarians with NSCLC who underwent curative resection from 1980 to 2002 was followed-up for outcomes.
  
  
  RESULTS
  Median age was 82 years old (range, 80-87 years old) consisting of 44 males (65%), with a mean follow-up of 32 months (range, 1-178 months). Operations included: 47 lobectomies (69%), 11 wedge resections (16%), 5 segmentectomies (8%), 4 bilobectomies (6%), and 1 pneumonectomy (1%). There were 31 adenocarcinomas (46%), 18 squamous carcinomas (26%), 12 bronchioalveolar carcinomas (18%), 4 large cell carcinomas (6%), and 3 miscellaneous malignant neoplasms (4%). Median hospital stay was 7 days (range, 3-53 days). Thirty-day mortality was 8.8% (n = 6) with 83% developing cardiopulmonary complications. Overall actuarial survival at 1, 3, and 5 years was 73%, 51%, and 34%, respectively. Of 41 patients (60%) with stage I disease, 23 were T1 lesions. Five-year survival was significantly different between stages Ia and Ib patients (61% and 10%, respectively, p = 0.001). Patients in more advanced stages had a 5-year survival of 3/27 (11%). Multivariate analysis identified advanced tumor stage, lower ASA physical status, and low FEV(1) as factors associated with poorer long-term survival.
  
  
  CONCLUSIONS
  The 5-year survival, particularly in patients with stage Ia tumors with favorable ASA and FEV(1), supports the notion that health status and tumor stage outweigh chronologic age in determining surgical candidates.
authors.affiliation: The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Malcolm V
authors.initials: MV
authors.lastname: Brock
authors.forename: Min P
authors.initials: MP
authors.lastname: Kim
authors.forename: Craig M
authors.initials: CM
authors.lastname: Hooker
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Alberg
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Jordan
authors.forename: Carmen M
authors.initials: CM
authors.lastname: Roig
authors.forename: Li
authors.initials: L
authors.lastname: Xu
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Yang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors