Influence of Age on Choice of Therapy and Surgical Outcomes in Patients with Nonsmall Cell Lung Cancer. Discussion

United States census data predict expansion of the elderly population until 2050 and nonsmall lung cancer (NSCLC) incidence is expected to rise accordingly. This study examines trends of lung cancer management and outcomes for pulmonary resection of primary NSCLC in the elderly. An institutional data set (n = 5950) was examined to determine patterns of management. A separate surgical dataset (n = 1756) was examined to determine surgical outcomes. "Elderly" was defined as 70 years old or older. Twenty-four per cent of patients in the institutional data set underwent surgery. Patients in the youngest age quartile (younger than 62 years) were more likely to undergo surgery, whereas the oldest quartile (older than 74 years) were less likely. In the surgical data set, 643 patients were elderly. No difference in combined 30-day/in-hospital mortality was noted (4 vs 2.9%). Five-year survival was 59.1 per cent for younger and 49.9 per cent for elderly patients. On multivariable analysis, age 70 years or older, male gender, increasing Charlson Comorbidity Index score, and pathologic stage were predictors of worse survival. Increasing age is an independent rick factor for surgical outcome and long-term survival after pulmonary resection for NSCLC, age appears to influence choice of initial treatment and extent of resection. Although surgery in the elderly carries higher risk, long-term cure can still be achieved in a significant number of patients. [PUBLICATION ABSTRACT]