Lung cancer in octogenarians: factors affecting long-term survival following resection.
OBJECTIVE
To identify factors associated with long-term survival following pulmonary resection for lung cancer in patients 80 years of age or older.


METHODS
The medical records of all patients >or=80 years, who underwent pulmonary resection for lung cancer from 1985 to 2002, were reviewed.


RESULTS
There were 294 patients (192 men, 102 women). Median age was 82 years (range 80-94 years). Overall 1-, 2-, and 5-year survival was 80%, 62%, and 34%, respectively. Histologic subtype, diabetes, renal insufficiency, prior myocardial infarction, congestive heart failure or stroke were not significantly associated with differences in 5-year survival. Female gender was associated with increased survival (36.2% vs 32.7% at 5 years, p=0.04). Extent of preoperative forced expiratory volume in 1s (FEV1) limitation did not influence survival. However, there were no 5-year survivors amongst patients with dyspnea as their presenting chief complaint, whereas there was a 35% 5-year survival in patients presenting without dyspnea (p<0.001). Five-year survival by pathologic stage was IA, 48%; IB, 39%; IIA, 17%; IIB, 23%; IIIA, 9%; and IIIB, 0% (p<0.001). Five-year survival of patients undergoing a lobectomy was 42% versus 11% for pneumonectomy (p<0.001).


CONCLUSIONS
Meaningful long-term survival is obtainable in elderly patients undergoing surgical resection for lung cancer. Careful patient evaluation and selection is necessary to identify patients who will benefit most from resection. Shorter survival was observed in male patients and those presenting with dyspnea. As could be expected, survival was also dependent on extent of resection and initial pathologic stage.
Dominguez-Ventura
Alberto
A
Division of General Thoracic Surgery, Mayo Clinic, 200 First Street, S.W., Rochester, MN 55905, USA.
Cassivi
Stephen D
SD
Allen
Mark S
MS
Wigle
Dennis A
DA
Nichols
Francis C
FC
Pairolero
Peter C
PC
Deschamps
Claude
C
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery; D002282:Adenocarcinoma, Bronchiolo-Alveolar / Q000401:mortality / Q000473:pathology / Q000601:surgery; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008168:Lung / Q000473:pathology / Q000601:surgery*; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D008297:Male; D009367:Neoplasm Staging; D013510:Pulmonary Surgical Procedures / Q000379:methods; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome