A retrospective comparative analysis of elderly and younger patients undergoing pulmonary resection for stage I non-small cell lung cancer.

Background: Age has been a critical predictor for immediate postoperative and long-term results after the pulmonary resection for lung cancer. In this study, we evaluated and compared surgical outcome of stage I non-small cell lung cancer and associated predictive factors between elderly and younger groups.

Methods: Short- and long-term outcomes of elderly group (≥70 years) who were surgically treated and pathologically diagnosed as stage I non-small cell lung cancer from 2004 to 2010 were compared to the results of younger group (<70 years).

Results: Total of 1340 patients were included in this study, and the patients were divided into the elderly group (n=285) and the younger group (n=1055). The proportions of squamous cell carcinoma (36.8 vs. 20.0%, p<0.001) and stage IB cancer (58.3 vs. 40.6%, p<0.001) were significantly higher in the elderly group than the younger group. The 30-day and 90-day mortalities were significantly higher in the elderly group (1.8 vs. 0%; p=0.014, 3.9 vs. 0.5%; p<0.001, respectively). The elderly patients also had significantly worse long-term outcomes than the younger group (5-year overall survival rate, 69.0 vs. 91.1%; p<0.001, 5-year disease-free survival rate, 53.3 vs. 80.2%; p<0.001). Decreased diffusion capacity less than 70% was an important predictive factor for short- and long-term outcomes in both the younger and the elderly group.

Conclusions: Elderly patients with low diffusion capacity are at risk for significantly worse outcome, indicating that patient selection should include assessment of pulmonary function, including diffusion capacity.