title: Results and impact of routine assessment of comorbidity in elderly patients with non-small-cell lung cancer aged > 80 years.
abstract: BACKGROUND
  Elderly patients now represent a bigger proportion of patients with non-small-cell lung cancer (NSCLC). However, data from clinical trials are limited for this age group, and the elderly are often excluded from optimal treatment for several reasons, including comorbidity.
  
  
  METHODS
  We reviewed a 10-year experience on proven patients with NSCLC aged > 80 years; comorbidity was assessed using the Charlson Comorbidity index (CCI). The main objective was the impact of comorbidity on survival outcome.
  
  
  RESULTS
  Of 109 managed patients aged > 80 years, 74 patients had a proven diagnosis of NSCLC. Performance status was < 2 in 58 patients and TNM classification of malignant tumors was I-II, IIIA-IIIB, and IV in 18, 27, and 29 patients, respectively. Comorbidity was present for 49 patients. Charlson Comorbidity Index ranged from 4 to 12 with 31 patients having a CCI >or= 6. Sixteen patients received supportive care only, whereas 23 patients were operated on, 12 received radiation therapy, and 23 had chemotherapy. Eight grade 3/4 toxicities were reported (3 patients discontinued treatment). Multivariate analysis demonstrated a significant increase in the risk of death for patients with a poor Eastern Cooperative Oncology Group performance status (hazard ratio, 2.64; 95% confidence interval, 1.3-5.36; P = 0.007) and an advanced TNM stage (hazard ratio, 3.31; 95% confidence interval, 1.99-5.5; P < 0.00001). Although statistic significance was not reached, a difference in overall survival was shown between patients with a CCI < 6 and CCI >or= 6 (12.2 months vs. 8.2 months; P = 0.08).
  
  
  CONCLUSIONS
  These results support a role for the CCI as a routine means to assess comorbidity, because patients with fewer comorbidities tolerate and derive survival benefit of optimal NSCLC management. These findings must be confirmed in prospective studies.
authors.affiliation: Department of Thoracic Oncology, Faculty of Medicine, Université de la Méditerranée, Assistance Publique Hôpitaux de Marseille, Hôpital Sainte-Marguerite, Marseille, France.
authors.forename: David
authors.initials: D
authors.lastname: Breen
authors.forename: Fabrice
authors.initials: F
authors.lastname: Barlési
authors.forename: Myriam
authors.initials: M
authors.lastname: Zemerli
authors.forename: Christophe
authors.initials: C
authors.lastname: Doddoli
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Torre
authors.forename: Pascal
authors.initials: P
authors.lastname: Thomas
authors.forename: Philippe
authors.initials: P
authors.lastname: Astoul
mesh_terms: D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D015897:Comorbidity; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D008297:Male; D012008:Recurrence; D016019:Survival Analysis