title: Defining the High-Risk Population for Mortality After Resection of Early Stage NSCLC.
abstract: The National Cancer Data Base was examined for predictors of 30-day mortality (30-DM) in early stage none small-cell lung cancer patients undergoing resection. The rate of 30-DM was 2.2%. Age, community treatment center, male sex, and Charlson-Deyo comorbidity score were predictive of higher mortality. Extent of resection was predictive of higher 30-DM in patients aged ‡ 75 years.
  
  
  BACKGROUND
  Studies examining morbidity after lobectomy for early stage non-small-cell lung cancer (NSCLC) demonstrate a > 50% incidence of complications in patients aged ≥ 65 years. Factors that affect 30-day mortality (30-DM), however, are less well defined.
  
  
  METHODS
  The National Cancer Data Base was used to identify patients age ≥ 19 years with stage I NSCLC between 2003 and 2011. Data from patients undergoing lobectomy or sublobar resection was abstracted. Univariable and multivariable logistic regression analyses were performed for predictors of 30-DM.
  
  
  RESULTS
  A total of 71,175 patients met inclusion criteria. Of these, 81% underwent lobectomy and 19% underwent sublobar resection. The median age was 68 years. Charlson-Deyo (CD) comorbidity score was 0 in 49% of patients and 1 or higher in 51%. The rate of 30-DM was 2.2%. On multivariable analysis, younger age, CD score of 0, female sex, tumor size ≤ 3 cm, and treatment at an academic center was associated with lower 30-DM (P < .001). A model of 30-DM incorporating age, comorbidity, and extent of surgery was created. In patients aged < 75 years without comorbidities, 30-DM was 1.3%. However, in elderly patients (≥ 75 years old) with CD score of 2, this rate quadrupled to 5.8% (P < .01). Lobectomy patients in this group had higher 30-DM compared to sublobar resection patients (6.6% vs. 3.9% respectively, P < .01).
  
  
  CONCLUSIONS
  The 30-DM rate following sublobar or lobar resection in this national sample was low. Extent of resection appears to influence 30-DM in the elderly. Elderly patients with a CD score of 2 undergoing lobectomy represent a high-risk group for 30-DM.
authors.affiliation: Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT. Electronic address: zain.husain@yale.edu.
authors.forename: Zain A
authors.initials: ZA
authors.lastname: Husain
authors.affiliation: Department of Thoracic Surgery, Yale School of Medicine, New Haven, CT.
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Kim
authors.affiliation: Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT.
authors.forename: James B
authors.initials: JB
authors.lastname: Yu
authors.affiliation: Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT.
authors.forename: Roy H
authors.initials: RH
authors.lastname: Decker
authors.affiliation: Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Corso
mesh_terms: D000367:Age Factors; D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D015897:Comorbidity; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000401:mortality / Q000601:surgery; D009367:Neoplasm Staging; D011013:Pneumonectomy; D044382:Population Groups; D012189:Retrospective Studies; D012306:Risk; D016019:Survival Analysis; D013997:Time Factors
keywords: 30-day mortality; Lobectomy; NCDB; NSCLC; Sublobar resection