Lobectomy in octogenarians with clinical stage Ⅰ non-small cell lung cancer-ten years of experience in a single center / 中华胸心血管外科杂志

ABSTRACT

Objective As the population ages,clinicians are increasingly confronted with octogenarians with early-staged non-small cell lung cancer(NSCLC).We reviewed the outcomes of octogenarians who underwent lobectomy for clinical stagc Ⅰ NSCLC,to determine whether there was a benefit to the VATS approach in this group,and to analysis the risk factors of complication and survival.Methods We conducted a retrospective single-institution review of patients age 80 years or greater who underwent lobectomy for NSCLC from January 2006 to December 2016.Clinical outcomes including complication rate and survival rate were analyzed.Results 162 octogenarians underwent lobectomy98 VATS and 64 through open thoracotomy.Compared with thoracotomy,VATS patients had fewer complications (14.3 ％ vs.28.1％,P =0.03),shorter length of tube duration [(3.5 ± 1.5) days vs.(4.9 ± 2.0) days,P =0.04],and shorter length of stay [(5.5 ± 2.1) days vs.(7.8 ± 3.5) days,P =0.04].For patients with pathologic stage Ⅰ disease,the 5-year overall survival was 64.5％,for stage Ⅱ was 38.1％,and for stage Ⅲ was 20.1％.The 5-year overall survival rates of pathological stage Ⅰ and stage Ⅱ,Ⅲ are of significant differences(P =0.001).In a multivariate logistic regression analysis,the approach of thoracotomy emerged as an independent predictor of complication (OR =1.94,95％ CI 1.214-5.135,P =0.03).In a multivariate COX regression analysis,pathological stage(OR =2.01,95％C1 1.453-5.865,P=0.03) and ASA(OR =1.81,95％CI 1.188-4.015,P =0.04) are independent predictors of over survival.Conclusion Octogenarians with NSCLC can undergo resection with low mortality and survival among stage Ⅰ patients,which is comparable with the general lung cancer population.The VATS approach reduces morbidity in this age demographic,resulting in shorter length of tube duration and shorter stay,while the approach of thoracotomy is an independent predictor of complication.Our study also demonstrated that pathological stage and ASA are independent predictors of overall survival rate.