title: A retrospective study of risk and prognostic factors in relation to lower respiratory tract infection in elderly lung cancer patients.
abstract: Lung cancer (LCa) is one of the most common and deadly malignancies in elderly patients. During the course of the disease, these patients frequently present with lower respiratory tract infection. Therefore, this study aims to investigate the clinical features of lower respiratory tract infection in elderly LCa patients and evaluate the impact on overall survival rate. Clinical and laboratory data were analyzed retrospectively for a total of 1936 patients that were over 60-years-old. Patients were classified into three groups based on pulmonary diseases: Group 1, lung cancer (LCa); Group 2, chronic obstructive pulmonary disease (COPD); and Group 3, other medical diseases without pulmonary problems (OMD). Univariate and multivariate analysis were used to evaluate related risk factors of infections and prognostic factors. The infection rate of the LCa group (46.25%) was significantly higher than the COPD (31.40%) and OMD (23.33%) groups. Polymicrobial infections were most prevalent in the LCa group (28.75%), which far exceeded the prevalence in COPD (11.05%) and OMD (4.44%) groups. In LCa patients, the most frequent pathogens were Gram-negative bacteria (44.87%), followed by fungi (34.62%) and Gram-positive bacteria (20.51%), the major pattern of polymicrobial infections was mixed Gram-negative bacteria and fungi (43.48%). Multivariate analysis revealed that COPD, pleural effusion, anatomical type, low cellular immune function, and length of hospital stay were related risk factors of lower respiratory tract infection in elderly LCa patients. A multivariate Cox proportional hazards regression model revealed that age, stage of TNM, surgical resection, antitumor therapy, lower respiratory tract infection, COPD, and pleural effusion were independent prognostic factors for cancer-related death. Patients who received effective antimicrobial treatment had a better outcome than those who did not respond to antimicrobial drugs (HR = 0.458, P < 0.05). Understanding lower respiratory tract infection in elderly LCa patients is vital if we are to set up corresponding measures and to target effective antimicrobial treatment.
authors: Department of Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai 200233, China.
authors: Dan
authors: D
authors: Qiao
authors: Department of Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai 200233, China.
authors: Zhiyu
authors: Z
authors: Wang
authors: Department of Clinical Skill Laboratory, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai 200233, China.
authors: Yaohong
authors: Y
authors: Lu
authors: Department of Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai 200233, China.
authors: Xiaoting
authors: X
authors: Wen
authors: Department of Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai 200233, China.
authors: Hongtao
authors: H
authors: Li
authors: Department of Oncology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Shanghai 200233, China.
authors: Hui
authors: H
authors: Zhao
keywords: Lung cancer; infection; prognosis; risk factors
references: J Clin Oncol. 2001 Apr 15;19(8):2123-33
references: 11304764
references: Clin Infect Dis. 2002 Mar 15;34(6):730-51
references: 11850858
references: Rev Mal Respir. 1992;9 Suppl 1:R49-52
references: 1317051
references: Br J Cancer. 1999 Mar;79(9-10):1479-86
references: 10188894
references: Thorax. 2003 Aug;58(8):711-20
references: 12885992
references: J Clin Oncol. 1990 Sep;8(9):1563-74
references: 2167954
references: Lung Cancer. 1994 Sep;11(3-4):243-9
references: 7812701
references: Am J Med. 1986 Jul 28;81(1A):11-26
references: 3526877
references: Eur J Cardiothorac Surg. 1998 Jul;14(1):40-4; discussion 44-5
references: 9726613
references: Ann Intern Med. 2005 Jun 21;142(12 Pt 1):979-95
references: 15968013
references: Thorax. 1996 Jun;51(6):564-8
references: 8693434
references: Eur J Cancer Care (Engl). 1999 Mar;8(1):37-43
references: 10362952
references: Am J Respir Crit Care Med. 1996 Nov;154(5):1450-5
references: 8912763
references: Am J Respir Crit Care Med. 2006 Jun 15;173(12):1316-25
references: 16556696
references: Ann Intern Med. 2011 Aug 2;155(3):179-91
references: 21810710
references: Chest. 2003 Jul;124(1):114-20
references: 12853512
references: Eur Rev Med Pharmacol Sci. 2013 Jan;17(1):8-18
references: 23329518
references: Drugs Aging. 2000 Sep;17(3):229-47
references: 11043821
references: Lung Cancer. 2001 Feb-Mar;31(2-3):101-10
references: 11165389
references: Eur Respir J. 1997 Feb;10(2):397-403
references: 9042639
references: J Crit Care. 2012 Jun;27(3):301-7
references: 21855281
references: Lung Cancer. 2001 Apr;32(1):81-8
references: 11282432
references: Chest. 2007 Mar;131(3):840-6
references: 17356101
references: Am J Respir Crit Care Med. 1999 Aug;160(2):397-405
references: 10430704
references: J UOEH. 2001 Sep 1;23(3):277-83
references: 11570051
references: Lung Cancer. 1998 Aug;21(2):105-13
references: 9829544
references: J Clin Oncol. 2001 Feb 15;19(4):1064-70
references: 11181670
references: Br J Cancer. 1990 Apr;61(4):597-604
references: 2158808
references: Age Ageing. 1988 May;17(3):181-6
references: 3389247
references: Arch Intern Med. 2000 Nov 13;160(20):3082-8
references: 11074737
references: Arch Intern Med. 1999 Sep 27;159(17):2058-64
references: 10510992
references: J Clin Epidemiol. 1999 Dec;52(12):1131-6
references: 10580775
references: Lung Cancer. 2001 Sep;33 Suppl 1:S115-20
references: 11576716
references: Cancer. 1990 Aug 1;66(3):593-6
references: 2364370
references: J Thorac Oncol. 2008 May;3(5):457-66
references: 18448996
references: Cancer. 2009 Jun 15;115(12):2721-31
references: 19402175
references: Tohoku J Exp Med. 1994 Aug;173(4):405-11
references: 7825174