title: Impact of Increasing Age on Cause-Specific Mortality and Morbidity in Patients With Stage I Non-Small-Cell Lung Cancer: A Competing Risks Analysis.
abstract: Purpose To perform competing risks analysis and determine short- and long-term cancer- and noncancer-specific mortality and morbidity in patients who had undergone resection for stage I non-small-cell lung cancer (NSCLC). Patients and Methods Of 5,371 consecutive patients who had undergone curative-intent resection of primary lung cancer at our institution (2000 to 2011), 2,186 with pathologic stage I NSCLC were included in the analysis. All preoperative clinical variables known to affect outcomes were included in the analysis, specifically, Charlson comorbidity index, predicted postoperative (ppo) diffusing capacity of the lung for carbon monoxide, and ppo forced expiratory volume in 1 second. Cause-specific mortality analysis was performed with competing risks analysis. Results Of 2,186 patients, 1,532 (70.1%) were ≥ 65 years of age, including 638 (29.2%) ≥ 75 years of age. In patients < 65, 65 to 74, and ≥ 75 years of age, 5-year lung cancer-specific cumulative incidence of death (CID) was 7.5%, 10.7%, and 13.2%, respectively (overall, 10.4%); noncancer-specific CID was 1.8%, 4.9%, and 9.0%, respectively (overall, 5.3%). In patients ≥ 65 years of age, for up to 2.5 years after resection, noncancer-specific CID was higher than lung cancer-specific CID; the higher noncancer-specific, early-phase mortality was enhanced in patients ≥ 75 years of age than in those 65 to 74 years of age. Multivariable analysis showed that low ppo diffusing capacity of lung for carbon monoxide was an independent predictor of severe morbidity ( P < .001), 1-year mortality ( P < .001), and noncancer-specific mortality ( P < .001), whereas low ppo forced expiratory volume in 1 second was an independent predictor of lung cancer-specific mortality ( P = .002). Conclusion In patients who undergo curative-intent resection of stage I NSCLC, noncancer-specific mortality is a significant competing event, with an increasing impact as patient age increases.
authors.affiliation: All authors: Memorial Sloan Kettering Cancer Center, New York, NY; Takashi Eguchi, Shinshu University, Matsumoto, Japan; and Ming-Ching Lee, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Eguchi
authors.affiliation: All authors: Memorial Sloan Kettering Cancer Center, New York, NY; Takashi Eguchi, Shinshu University, Matsumoto, Japan; and Ming-Ching Lee, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Sarina
authors.initials: S
authors.lastname: Bains
authors.affiliation: All authors: Memorial Sloan Kettering Cancer Center, New York, NY; Takashi Eguchi, Shinshu University, Matsumoto, Japan; and Ming-Ching Lee, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Ming-Ching
authors.initials: MC
authors.lastname: Lee
authors.affiliation: All authors: Memorial Sloan Kettering Cancer Center, New York, NY; Takashi Eguchi, Shinshu University, Matsumoto, Japan; and Ming-Ching Lee, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Kay See
authors.initials: KS
authors.lastname: Tan
authors.affiliation: All authors: Memorial Sloan Kettering Cancer Center, New York, NY; Takashi Eguchi, Shinshu University, Matsumoto, Japan; and Ming-Ching Lee, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Boris
authors.initials: B
authors.lastname: Hristov
authors.affiliation: All authors: Memorial Sloan Kettering Cancer Center, New York, NY; Takashi Eguchi, Shinshu University, Matsumoto, Japan; and Ming-Ching Lee, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Buitrago
authors.affiliation: All authors: Memorial Sloan Kettering Cancer Center, New York, NY; Takashi Eguchi, Shinshu University, Matsumoto, Japan; and Ming-Ching Lee, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Manjit S
authors.initials: MS
authors.lastname: Bains
authors.affiliation: All authors: Memorial Sloan Kettering Cancer Center, New York, NY; Takashi Eguchi, Shinshu University, Matsumoto, Japan; and Ming-Ching Lee, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Downey
authors.affiliation: All authors: Memorial Sloan Kettering Cancer Center, New York, NY; Takashi Eguchi, Shinshu University, Matsumoto, Japan; and Ming-Ching Lee, National Yang-Ming University, Taipei, Taiwan.
authors.forename: James
authors.initials: J
authors.lastname: Huang
authors.affiliation: All authors: Memorial Sloan Kettering Cancer Center, New York, NY; Takashi Eguchi, Shinshu University, Matsumoto, Japan; and Ming-Ching Lee, National Yang-Ming University, Taipei, Taiwan.
authors.forename: James M
authors.initials: JM
authors.lastname: Isbell
authors.affiliation: All authors: Memorial Sloan Kettering Cancer Center, New York, NY; Takashi Eguchi, Shinshu University, Matsumoto, Japan; and Ming-Ching Lee, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Park
authors.affiliation: All authors: Memorial Sloan Kettering Cancer Center, New York, NY; Takashi Eguchi, Shinshu University, Matsumoto, Japan; and Ming-Ching Lee, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Valerie W
authors.initials: VW
authors.lastname: Rusch
authors.affiliation: All authors: Memorial Sloan Kettering Cancer Center, New York, NY; Takashi Eguchi, Shinshu University, Matsumoto, Japan; and Ming-Ching Lee, National Yang-Ming University, Taipei, Taiwan.
authors.forename: David R
authors.initials: DR
authors.lastname: Jones
authors.affiliation: All authors: Memorial Sloan Kettering Cancer Center, New York, NY; Takashi Eguchi, Shinshu University, Matsumoto, Japan; and Ming-Ching Lee, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Prasad S
authors.initials: PS
authors.lastname: Adusumilli
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D002423:Cause of Death; D015897:Comorbidity; D018572:Disease-Free Survival; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008168:Lung / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008175:Lung Neoplasms / Q000401:mortality* / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009519:New York City / Q000453:epidemiology; D011013:Pneumonectomy / Q000009:adverse effects / Q000401:mortality*; D016016:Proportional Hazards Models; D011653:Pulmonary Diffusing Capacity; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome