Validation of a model to predict perioperative mortality from lung cancer resection in the elderly.
BACKGROUND
Surgical resection is the mainstay therapy for localized non-small cell lung cancer (NSCLC), yet elderly patients are less likely to be treated due to concerns about morbidity and mortality related to surgery.


OBJECTIVE
To validate and refine a clinical model to predict 30-day perioperative mortality (POM) in elderly patients undergoing curative resection for lung cancer.


METHODS
We identified 14,297 patients aged 65 years and older with stage I, II, or IIIA NCSLC from the Surveillance, Epidemiology, and End-Results Registry linked to Medicare claims. We used logistic regression analysis to identify independent risk factors for POM and to validate and refine a previously derived prediction model.


RESULTS
Overall, POM was 4.6% (95% confidence interval, 4.2-4.9%). Multiple regression analysis revealed that greater age, male sex, resections of multiple lobes, advanced stage, greater tumor size, and certain comorbidities were associated with increased risk for POM. These risk factors were similar to those observed in the prior model. When patients were stratified according to their predicted risk of POM, the observed mortality increased from 1.2 to more than 10%.


CONCLUSIONS
Among elderly patients with lung cancer, a prediction rule can identify those patients at higher risk for fatal complications from surgery. Further studies should evaluate whether use of the model can lead to improvements in treatment decision making.
Kates
Max
M
Mount Sinai School of Medicine, New York, New York 10029, USA.
Perez
Xavier
X
Gribetz
Julie
J
Swanson
Scott J
SJ
McGinn
Thomas
T
Wisnivesky
Juan P
JP
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008175:Lung Neoplasms / Q000401:mortality* / Q000601:surgery*; D008297:Male; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012737:Sex Factors; D014481:United States / Q000453:epidemiology