Long-term Results of Surgical Treatment for Primary Lung Cancer in the Elderly

Abstract

Objective. This study investigated the usefulness of surgical treatment for primary lung cancer in the elderly, mainly based on the long-term results. Methods. A total of 1374 patients underwent surgery for primary lung cancer in our unit between 1979 and 2000 and this group was retrospectively investigated. We mainly investigated long-term survival in three groups of patients: those 65 or younger (group Y, n=578), those between 66 and 75 (group M, n=629), and those 76 or older (group E, n=167). The survival rate was statistically analyzed using the Kaplan-Meier method and the significance of differences was analyzed by the log-rank test. Results. The proportion of limited procedures in group E (16%) was higher than that in groups Y (4%) and M (6%). The ratio of squamous cell carcinomas in group Y (25%) was lower than that in groups M (38%) and E (40%). The ratio of pathological stage I disease in group E (73%) was higher than that in groups Y (54%) and M (57%). The early postoperative (operative + hospital) mortality rate in group E (3.5%) was higher than those in groups Y (1.0%) and M (1.1%), while there were no early postoperative deaths between 1997 and 2000. The overall 5-and 10-year survival rates were 66% and 53% in group Y, 60% and 45% in group M, and 47% and 27% in group E, respectively. There was a significant difference (p<0.001) between these three groups, but there was no difference after the survival rates of these three groups were adjusted based on the Japanese life table. The 5-and 10-year survival rates in stage I disease of non-small cell lung cancer were 82% and 71% in group Y, 70% and 54% in group M, and 52% and 33% in group E, respectively. There was a significant difference (p<0.001) between these three groups, but there was no difference after the adjustment of the survival rates. The 5-and 10-year survival rates in stages II and III were 44% and 39% in group Y, 44% and 39% in group M, and 40% and none in group E, respectively. There was no difference between these three groups prior to the adjustment of the survival rates. Conclusion. The 5-and 10-year survival rates seemed poor in the elderly, but there was no difference between the three age groups after the survival rates of these three groups were adjusted based on the Japanese life table. Therefore, it was thought that elderly patients as well as younger patients were good candidates for lung resection.