Outcomes After Surgical Management of Early-Stage Lung Cancer in Octogenarians: An in-depth Analysis of a Nationally Representative Cohort.

Abstract

IntroductionAs the U.S. population ages more octogenarians are undergoing surgical resection for lung cancer (LC). We aimed to provide an updated and expanded assessment of age-related risks associated with surgical resections for early-stage NSCLC.

Methods: Surveillance, Epidemiology and End Results (SEER) and Medicare databases were queried for stage IA NSCLC cases treated by surgery between 2006-2018. Analyses included generalized linear models for 1-year mortality and Cox proportional hazards models for 5-year survival.

Results: One-year all-cause mortality among 4,061 octogenarians was more than double that of the youngest group (age 65-69): 15.2% vs 7.3%, p<0.001. Octogenarians were discharged to extended skilled nursing facility (SNF) stays more than three times as often as the youngest group (19.9% vs 6.3%, p<0.001). For those with SNF duration > 30 days there was a 36% greater 1- year mortality risk compared to those discharged home or to home-health. In adjusted analyses, octogenarians had 62% greater 1- year mortality risk compared with those <80 (RR: 1.62, 95% CI: 1.48, 1.78). Risk of death within 5 years was 52% higher: (HR: 1.52, 95% CI: 1.42, 1.62). Additional factors associated with 1-year mortality included male sex, higher comorbidity burden, lower county median income, open approach and sub-lobar resection.

Conclusions: This analysis provides an updated and expanded characterization of age-related outcomes based on a large national cohort representative of elderly patients treated outside of clinical trials. Substantial gaps in survival and discharge disposition motivate further research and the development of interventions to help improve outcomes in older patients.