title: Outcomes of lobectomy in 'active' octogenarians with clinical stage I non-small-cell lung cancer.
abstract: BACKGROUND
  In octogenarians with early stage of lung cancer, sublobar resection has been shown to be no inferior survival to lobectomy. However, some octogenarians remain physically and mentally active.
  
  
  METHODS
  We retrospectively studied 65 octogenarians who underwent curative resection for clinical stage I NSCLC (excluding adenocarcinoma in situ). All patients were assessed by cardiologists and underwent stair-climbing tests (five flights, 18 m) and cognitive function tests. Lobectomy was performed in patients who could climb 5 flights of stairs without stopping or oxygen desaturation of >4%.
  
  
  RESULTS
  The actuarial survival rate was 68.6% at 5 years, and the median survival time was 109.2 months. Forty-three patients met the criteria for lobectomy. As compared with sublobar resection, lobectomy was associated with significantly higher rates of overall survival (78.4% vs. 48.5%; p = 0.02) and disease-specific survival (88.4% vs. 61.7%; p = 0.02) at 5 years. On multivariate analysis, male sex (hazard ratio, 3.827; 1.382-10.596) and sublobar resection (2.261; 1.054-5.360) were independent risk factors for survival. Mental disorders occurred in 6 patients (9.2%), and their score on preoperative cognitive function tests was significantly lower than that of patients without mental disorders (22.7 vs. 26.0, p <0.01).
  
  
  CONCLUSIONS
  Outcomes of lobectomy are good in physically and mentally competent octogenarians.
authors.affiliation: Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ito
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Nakayama
authors.forename: Kouzo
authors.initials: K
authors.lastname: Yamada
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Yokose
authors.forename: Munetaka
authors.initials: M
authors.lastname: Masuda
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D003071:Cognition; D018572:Disease-Free Survival; D005080:Exercise Test; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008603:Mental Health; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009483:Neuropsychological Tests; D010809:Physical Fitness; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome
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