Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Clinical Features and Prognostic Factors in Elderly Koreans with Advanced Non-Small-Cell Lung Cancer in a Tertiary Referral Hospital

  • Kim, Seo Woo (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Medical Center and Ewha Medical Research Institute, Ewha Womans University School of Medicine) ;
  • Kim, Mi Yeon (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Medical Center and Ewha Medical Research Institute, Ewha Womans University School of Medicine) ;
  • Lee, Yoon Pyo (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Medical Center and Ewha Medical Research Institute, Ewha Womans University School of Medicine) ;
  • Ryu, Yon Ju (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Medical Center and Ewha Medical Research Institute, Ewha Womans University School of Medicine) ;
  • Lee, Seok Jeong (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Medical Center and Ewha Medical Research Institute, Ewha Womans University School of Medicine) ;
  • Lee, Jin Hwa (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Medical Center and Ewha Medical Research Institute, Ewha Womans University School of Medicine) ;
  • Chang, Jung Hyun (Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Medical Center and Ewha Medical Research Institute, Ewha Womans University School of Medicine) ;
  • Shim, Sung Shine (Department of Radiology, Ewha Medical Center and Ewha Medical Research Institute, Ewha Womans University School of Medicine)
  • Received : 2013.04.08
  • Accepted : 2013.05.27
  • Published : 2013.08.30
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Abstract

Background: More than half of cases for advanced non-small-cell lung cancer (NSCLC) occur in elderly patients with a median age at diagnosis of 70 years. The aim of our study was to examine the clinical features and prognostic factors contributing to mortality in elderly patients with advanced NSCLC. Methods: Following a retrospective review of clinical data, 122 patients aged 70 years and over with a histopathological diagnosis of locally advanced (stage IIIB, n=32) and metastatic (stage IV, n=90) NSCLC between 2005 and 2011 were enrolled. Results: The median age was 76 years (interquartile range, [IQR], 72-80 years), and 85 (70%) patients were male. Fifty-seven (46%) patients had never smoked, and 17 (19%) were in a malnourished state with a body mass index (BMI) of <$18.5kg/m^2$. The initial treatments included chemotherapy (40%) and radiotherapy (7%), but 57% of the patients received supportive care only. The 1-year survival rate was 32%, and the 3-year survival rate was 4%, with a median survival duration of 6.2 months (IQR, 2.5-15.3 months). Male gender (hazard ratio [HR], 2.2; 95% confidence interval [CI], 1.3-3.9; p=0.005), low BMI (HR, 2.3; 95% CI, 1.3-3.9; p=0.004), and supportive care only (HR, 1.9; 95% CI, 1.2-2.9; p=0.007) were independent predictors of shorter survival based on a Cox proportional hazards model. Conclusion: Elderly patients with advanced NSCLC had a poor prognosis, particularly male patients, those with a low BMI, and those who received supportive care only.

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References

  1. Jung KW, Park S, Kong HJ, Won YJ, Lee JY, Park EC, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2008. Cancer Res Treat 2011;43:1-11. https://doi.org/10.4143/crt.2011.43.1.1
  2. Kim YC, Kwon YS, Oh IJ, Kim KS, Kim SY, Ryu JS, et al. National survey of lung cancer in Korea, 2005. J Lung Cancer 2007;6:67-73. https://doi.org/10.6058/jlc.2007.6.2.67
  3. Goldstraw P, Crowley J, Chansky K, Giroux DJ, Groome PA, Rami-Porta R, et al. The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol 2007;2:706-14. https://doi.org/10.1097/JTO.0b013e31812f3c1a
  4. Jung SY, Park DI, Park MR, Jung SS, Kim JO, Kim SY, et al. Clinical characteristics of patients older than 76 with lung cancer. Korean J Med 2012;82:562-8. https://doi.org/10.3904/kjm.2012.82.5.562
  5. Gridelli C, Perrone F, Gallo C, Cigolari S, Rossi A, Piantedosi F, et al. Chemotherapy for elderly patients with advanced nonsmall- cell lung cancer: the Multicenter Italian Lung Cancer in the Elderly Study (MILES) phase III randomized trial. J Natl Cancer Inst 2003;95:362-72. https://doi.org/10.1093/jnci/95.5.362
  6. Schild SE, Stella PJ, Geyer SM, Bonner JA, McGinnis WL, Mailliard JA, et al. The outcome of combined-modality therapy for stage III non-small-cell lung cancer in the elderly. J Clin Oncol 2003;21:3201-6. https://doi.org/10.1200/JCO.2003.12.019
  7. The World Health Organization histological typing of lung tumours. Second edition. Am J Clin Pathol 1982;77:123-36. https://doi.org/10.1093/ajcp/77.2.123
  8. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin 2012;62:10-29. https://doi.org/10.3322/caac.20138
  9. Kim HS, Hyun DS, Kim KC, Lee SC, Jung TH, Park JY, et al. The clinical characteristics and prognosis of elderly patient with lung cancer diagnosed in Daegu and Gyeongsangbukdo. Tuberc Respir Dis 2008;65:15-22. https://doi.org/10.4046/trd.2008.65.1.15
  10. Hsu CL, Chen KY, Shih JY, Ho CC, Yang CH, Yu CJ, et al. Ad vanced non-small cell lung cancer in patients aged 45 years or younger: outcomes and prognostic factors. BMC Cancer 2012;12:241. https://doi.org/10.1186/1471-2407-12-241
  11. Jang TW, Kim YC, Kwon YS, Oh IJ, Kim KS, Kim SY, et al. Female lung cancer: re-analysis of national survey of lung cancer in Korea, 2005. J Lung Cancer 2010;9:57-63. https://doi.org/10.6058/jlc.2010.9.2.57
  12. Berghmans T, Paesmans M, Sculier JP. Prognostic factors in stage III non-small cell lung cancer: a review of conventional, metabolic and new biological variables. Ther Adv Med Oncol 2011;3:127-38. https://doi.org/10.1177/1758834011401951
  13. Rivera MP, Stover DE. Gender and lung cancer. Clin Chest Med 2004;25:391-400. https://doi.org/10.1016/j.ccm.2004.01.006
  14. Brown JS, Eraut D, Trask C, Davison AG. Age and the treatment of lung cancer. Thorax 1996;51:564-8. https://doi.org/10.1136/thx.51.6.564
  15. Montella M, Gridelli C, Crispo A, Scognamiglio F, Ruffolo P, Gatani T, et al. Has lung cancer in the elderly different characteristics at presentation? Oncol Rep 2002;9:1093-6.
  16. Van Cutsem E, Arends J. The causes and consequences of cancer-associated malnutrition. Eur J Oncol Nurs 2005;9 Suppl 2:S51-63. https://doi.org/10.1016/j.ejon.2005.09.007
  17. Yang R, Cheung MC, Pedroso FE, Byrne MM, Koniaris LG, Zimmers TA. Obesity and weight loss at presentation of lung cancer are associated with opposite effects on survival. J Surg Res 2011;170:e75-83. https://doi.org/10.1016/j.jss.2011.04.061
  18. Luo J, Chen YJ, Narsavage GL, Ducatman A. Predictors of survival in patients with non-small cell lung cancer. Oncol Nurs Forum 2012;39:609-16. https://doi.org/10.1188/12.ONF.609-616
  19. Langer CJ. Clinical evidence on the undertreatment of older and poor performance patients who have advanced nonsmall- cell lung cancer: is there a role for targeted therapy in these cohorts? Clin Lung Cancer 2011;12:272-9. https://doi.org/10.1016/j.cllc.2011.02.001

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