Influence of age and comorbidity on treatment strategies and survival time of elderly patients with advanced non-small cell lung cancer / 肿瘤

ABSTRACT

Objective: This study was designed to identify the influence of age and comorbidity on the treatment strategies and survival time of the elderly patients(≥70 years) with advanced (stage III B or IV) non-small cell lung cancer (NSCLC). Methods: The clinical characteristics, treatment strategies and survival features of 127 elderly patients with a good performance status (PS≤1) were retrospectively analyzed. They were diagnosed as NSCLC and received chemotherapy in our oncological department between January 2005 and December 2005. These patients were stratified by age into two groups: 70-74 years group and ≥75 years group; and divided into three groups based on the degree of comorbidity: no comorbidity (0), mild comorbidity (1-2) and severe comorbidity (≥3) groups. Their relationship with clinical features, treatment strategies, and survival time was analyzed. Results: More than 50% patients in 70-74 years group (51.2%) were treated with cisplatin-based combination therapy, while only 20.6% patients in ≥75 years group received cisplatin-based combination therapy (P=0.003). There were 37.0% patients in the severe comorbidity group received palliative radiotherapy, which was significantly higher than that of the no or moderate comorbidity groups (21.7% and 11.7%, P=0.014). In 70-74 years group and ≥75 years group, the 1-year survival rate was 41.4% and 35.3% (log-rank, P=0.319). In no, mild and severe comorbidity group, the 1-year survival rate was 53.5%, 41.3%, and 20.8%, respectively (log-rank, P=0.071). In univariate and multivariate COX model analyses, age and mild comorbidity did not increase the risk of survival, but severe comorbidity was an independent risk factor for the survival of elderly patients with NSCLC; the relative risk ratio (95% confidence interval) was 2.09 (1.06-4.15) and 2.56 (1.18-5.76) (P=0.034 and 0.023). Conclusions: Different treatment strategies should be given to elderly patients with advanced NSCLC according to the age or the degree of comorbidity. Severe comorbidity is an independent risk factor for survival of elderly patients with advanced NSCLC.