LUNG-CANCER SURGERY IN ELDERLY PATIENTS

Aims and background: Bronchogenic carcinoma is the major cancer-relate d cause of death in patients aged 70 years and over, and its incidence is rising. The aim of our study was to compare the incidence and the prognostic effect of the parameters characterizing resected patients w ith non-small-cell lung cancer (NSCLC) when stratified by age. Of 283 NSCLC patients candidates to a long-term follow-up program and who und erwent pulmonary resection in our Unit, 34 (12%) were older than 70 ye ars. Methods: All patients had been preoperatively selected to exclude those with severe or multiple organ system disease and staged in acco rdance with the UICC classification. Results: When univariate and mult ivariate analyses were performed within the elderly group, exclusively epidermoid carcinoma and multiple tumor nodules emerged as independen t poor prognostic factors (hazard risk, 5.77 and 7.33, respectively). In comparing the older and younger groups, a higher incidence of previ ous primary neoplastic disease (P=0.001), epidermoid carcinoma (P<0.05 ) and multiple tumor nodules (P<0.001) was observed in the elderly. Po stoperative death was similar (3% vs 4.8%) in the two age groups, as w as survival expectancy when stratified by stage. However, univariate a nalysis showed that epidermoid carcinoma (P=0.001) and pneumonectomy ( P=0.00001) had a worse outcome in the older early stage subset than in the younger group. When multivariate analysis was performed in all ea rly stage patients, only lymph node involvement and multiple tumor nod ules were independently related to survival (hazard risk, 1.82 and 3.7 6, respectively) and had a poor prognosis. In more advanced disease, e lderly and younger patients had a similar outcome. Conclusions: Our re sults confirm that a patient's advanced age is not a risk factor in de ciding on pulmonary resection, at least for stage I and II NSCLC, and suggest that in all patients, irrespective of age, stage and histologi c cell type, the presence of multiple tumor nodules is the only true p rognostic factor with a very low survival rate.