title: Survival and risk of adverse events in older patients receiving postoperative adjuvant chemotherapy for resected stages II-IIIA lung cancer: observational cohort study.
abstract: OBJECTIVE
  To compare the survival and risk of serious adverse events in older patients with stages II-IIIA non-small cell lung cancer treated with or without postoperative platinum based chemotherapy.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  Cases of lung cancer in Surveillance Epidemiology and End Results registry linked to Medicare files, 1992-2005, and follow-up data to December 2007.
  
  
  METHODS
  3324 patients aged more than 65 years with resected stages II-IIIA lung cancer.
  
  
  METHODS
  Primary outcome was overall survival and secondary outcome was the rate of serious adverse events among older patients treated with or without adjuvant chemotherapy.
  
  
  RESULTS
  Overall, 21% (n = 684) of patients received platinum based chemotherapy. Analyses adjusted, stratified, or matched by propensity scores showed that chemotherapy was associated with improved survival (hazard ratio range 0.78-0.81). The beneficial effect of chemotherapy was also observed among patients treated with radiation therapy (0.75-0.77) or without radiation therapy (0.74-0.77); however, chemotherapy was not beneficial for patients aged 80 or more (1.32-1.46). Adjuvant chemotherapy was associated with an increased odds of serious adverse events (odds ratio 2.0, 95% confidence interval 1.5 to 2.6).
  
  
  CONCLUSIONS
  Platinum based adjuvant chemotherapy is associated with reduced mortality and increased risk of serious adverse events in older patients with stages II-IIIA lung cancer. The magnitude of the benefit is similar to that observed in randomised controlled trials carried out among selected patients.
authors.affiliation: Division of General Internal Medicine, Mount Sinai School of Medicine, One Gustave L Levy Place, Box 1087, New York, NY 10029, USA. juan.wisnivesky@mssm.edu
authors.forename: Juan P
authors.initials: JP
authors.lastname: Wisnivesky
authors.forename: Cardinale B
authors.initials: CB
authors.lastname: Smith
authors.forename: Stuart
authors.initials: S
authors.lastname: Packer
authors.forename: Gary M
authors.initials: GM
authors.lastname: Strauss
authors.forename: Linda
authors.initials: L
authors.lastname: Lurslurchachai
authors.forename: Alex
authors.initials: A
authors.lastname: Federman
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Halm
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects / Q000401:mortality; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D008297:Male; D017671:Platinum Compounds / Q000009:adverse effects / Q000627:therapeutic use*; D011182:Postoperative Care / Q000379:methods / Q000401:mortality; D012042:Registries; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents; D017671:Platinum Compounds