title: Advanced non-small cell lung cancer in the elderly: the impact of age and comorbidities on treatment modalities and patient prognosis.
abstract: OBJECTIVE
  Data on the treatment modalities and prognostic factors for elderly patients with advanced non-small cell lung cancer (NSCLC) remain limited. This study investigates the impact of age and comorbidities on treatment modalities and patient prognosis.
  
  
  METHODS
  From January 2004 to December 2008, patients aged ≥70years old and diagnosed with stage IIIB or IV NSCLC were included retrospectively. Their clinical characteristics were reviewed and analyzed. Comorbidity status was evaluated using Charlson comorbidity index (CCI) and simplified comorbidity score (SCS).
  
  
  RESULTS
  A total of 576 patients were included in this analysis. Four hundred and nineteen patients (72.7%) received systemic therapy, including 182 (31.6%) patients who received chemotherapy, and 237 (41.1%) patients who received epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) as initial treatment. Patients aged ≥80 were less likely to receive chemotherapy as initial treatment than those aged 70-79 (12.3% vs. 40.9%, p<0.001). There was no significant difference in proportion of chemotherapy between patients with high and low comorbidity score. Receipt of systemic therapy, male gender, PS≥2, and histologic type were associated with a poorer prognosis. In the multivariate analysis, which included the comorbidity items of SCS, cigarette smoking (HR: 1.73, 95% CI: 1.36-2.21), age ≥80 (HR: 1.30, 95% CI: 1.01-1.67), and PS ≥2 (HR: 3.07, 95% CI: 2.37-3.98) were associated with a shorter survival period.
  
  
  CONCLUSIONS
  Age may limit chemotherapy use for elderly patients with NSCLC. Cigarette smoking is an important independent prognostic factor for this particular population.
authors.affiliation: Division of Pulmonary Medicine, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Chia-Lin
authors.initials: CL
authors.lastname: Hsu
authors.affiliation: Department of Geriatrics and Gerontology, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan.
authors.forename: Jen-Hau
authors.initials: JH
authors.lastname: Chen
authors.affiliation: Division of Pulmonary Medicine, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan. Electronic address: tuff.chen@msa.hinet.net.
authors.forename: Kuan-Yu
authors.initials: KY
authors.lastname: Chen
authors.affiliation: Division of Pulmonary Medicine, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan.
authors.forename: Jin-Yuan
authors.initials: JY
authors.lastname: Shih
authors.affiliation: Department of Oncology, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan.
authors.forename: James Chih-Hsin
authors.initials: JC
authors.lastname: Yang
authors.affiliation: Division of Pulmonary Medicine, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan.
authors.forename: Chong-Jen
authors.initials: CJ
authors.lastname: Yu
authors.affiliation: Division of Pulmonary Medicine, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan.
authors.forename: Pan-Chyr
authors.initials: PC
authors.lastname: Yang
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000453:epidemiology; D015897:Comorbidity; D066246:ErbB Receptors / Q000037:antagonists & inhibitors; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D047428:Protein Kinase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D013624:Taiwan / Q000453:epidemiology
chemical_list: D047428:Protein Kinase Inhibitors; D066246:ErbB Receptors
keywords: Chemotherapy; EGFR-TKI; Elderly; Lung cancer; Prognosis; Survival