NSCLC in Patients Older Than Age 75: Risks and Benefits of Surgery

By: Joshua D. Madera, MD
Posted: Tuesday, August 27, 2024

According to a single-center observational study published in the Journal of Cardiothoracic Surgery, the increased risk of morbidity and mortality in elderly patients with lung cancer has prompted investigative efforts to identify strategies to minimize this risk and improve surgical outcomes. A multidisciplinary approach to care may improve clinical outcomes in this patient population, explained Andrey Kaprin, MD, PhD, of the Federal State Budget Institution National Medical Research Radiology Centre of the Ministry of Healthcare of the Russian Federation, Moscow, and colleagues.

“Each case of lung cancer in patients aged 75 and older necessitates an individualized approach,” noted the investigators.

From 2015 to 2021, a total of 73 patients with non–small cell lung cancer (NSCLC) were recruited for the study. All patients were at least 75 years old. A multidisciplinary team consisting of cardiothoracic surgeons, anesthesiologists, and additional medical specialists performed a comprehensive preoperative evaluation on all patients. Subsequently, patients were treated surgically and were monitored to assess clinical outcomes.

The study findings revealed postoperative morbidity and mortality rates of 16.4% and 5.5%, respectively. Common complications experienced by patients included atrial fibrillation (41.6%), persistent air leak (33.3%), and pneumonia (25%). In addition, 88% of patients were free of relapse at the 1-year follow-up visit; this rate decreased to 66% at the 3-year follow-up visit. The observed overall survival rates were 71%, 66%, and 35% at the 1-year, 3-year, and 5-year intervals, respectively. Furthermore, clinical factors including stage IIIb, pN1, pN2, and centrally located disease were significantly associated with a complex postoperative recovery. Significant associations were identified between overall survival and the need for thoracotomy, stage Ia2 disease, and a Charlson comorbidity index of 6.

Disclosure: The study authors reported no conflicts of interest.

Journal of Cardiothoracic Surgery