PURPOSE: The average age of patients with lung cancer is increasing and more than half of advanced non-small cell lung cancer (NSCLC) occurs in elderly with a median age at diagnosis of 70 years. The aim of our study was to examine the clinical outcomes and prognostic factors contributing to mortality in elderly patients with advanced NSCLC.
METHODS: 85 patients aged 70 years and over receiving a histopathological diagnosis of locally advanced (14 with stage IIIB disease) NSCLC and metastatic NSCLC (71 with stage IV disease) were collected between 2005 and 2009, and reviewed retrospectively.
RESULTS: The median age of the patients was 75 years (range, 70-90), and 61 patients (72%) were male. 39 patients (46%) were never-smokers and 11 patients (13%) were in a malnourished state, with body mass index < 18.5 kg/m2. Histologic types were as follows: squamous, 34%; adenocarcinoma, 33%; non-small cell type, 25%; large cell carcinoma, 2%; and others, 6%. The initial treatments included chemotherapy (52%) and radiotherapy (7%), but 44% of the patients received supportive care only. Overall mortality was 78% (66/85), with a median survival of 6 months (range, 1-42) after diagnosis. One-year survival was 39.9% and three-year survival was 9.0%. Cancer progression was noted as a primary cause of death in 59 patients (69%). The 7 patients who died of other causes, such as a infection (n=4), ischemic heart disease (n = 2), and cerebrovascular accident (n=1) were excluded from the survival analysis. Regardless of age, nutritional status, stage IV disease, initial treatment or lung function, male gender (hazard ratio (HR), 9.6; 95% confidence interval (CI), 2.8-33.6; p<0.0001) and smoking history (HR, 4.4; 95% CI, 1.5-12.5; p=0.006) were independent predictors of shorter survival based on a Cox proportional hazards model.
CONCLUSIONS: A substantial portion of elderly patients with advanced NSCLC did not receive standard treatment. Never-smokers and women were better survival factors in elderly patients with advanced NSCLC.
CLINICAL IMPLICATIONS: Despite of eldery patients wiht advanced NSCLC, appropriate therapy was considered at women and Never-smokers.
DISCLOSURE: The following authors have nothing to disclose: Seowoo Kim, Yon Ju Ryu, Jung Hyun Chang, Jin Hwa Lee, Yun Su Shim, Sung Shine Shim
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