Is patient outcome in surgery for lung cancer determined by age?

The study investigated the effect of age on the outcome of patients being treated with surgery for early stage NSCLC.

Non small-cell lung cancer (NSCLC) is a common form of lung cancer that can be difficult to treat. Treatment for early stage (stage 1 & 2) involves lobectomy (surgery to remove part of the lung); however if this is not possible there are other options. These include radiation therapy (uses radiation to kill cancer cells by damaging their DNA) and pneumonectomy (surgery to remove a lung). Patient eligibility for either is based on factors like cancer stage, lung function and age. However, pneumonectomies have been linked to higher mortality (death) rates and poorer quality of life in the elderly.

The aim of this study was to investigate the effect of age on the outcome of patients being treated for NSCLC.

5,701 patients with stage I or II NSCLC were selected as part of this investigation. Patients were divided into study groups based on age and tumour stage. Four study groups were arranged based on age profiles; under 50, 50 to 69 years, 70 to 79 years, and 80 years and older. A control group of 436 patients who were eligible for surgery but refused and chose radiotherapy instead was also used.

Overall 5-year survival rate of patients was shown to decrease as age increased. Patients in the under 50 group had the highest survival (49.8%) and it fell for each subsequent study group; 50 to 69 years (40.5%), 70 to 79 years (28.9%), and over 80 years (18.8%).For every increasing decade, there was a 34% increased risk of death within 5 years of treatment. 

When compared to the radiotherapy control group it was shown that pneumonectomy had a positive effect on patient survival in all age groups and patients with stage 1 had higher overall 5-year survival (42.1%) than those with stage 2 (32.4%).

5-year survival in patients under 70 who received a pneumonectomy was  55.6% compared to 27.1% in the radiotherapy group. Likewise patients in the 70 or older group who underwent pneumonectomy had a higher survival (37.5%) than those in the radiotherapy group (21.6%).

Age was shown to be a determining factor in patient outcome after pneumonectomy. Overall, surgical options were shown to confer the longest overall 5-year survival when compared to the alternative, radiotherapy.

Consult with your physician about your treatment options if being treated for early stage NSCLC and concerned about your age.