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* From the Division of Thoracic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA.
Correspondence to: Michael T. Jaklitsch, MD, FCCP, Division of Thoracic Surgery, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115; e-mail: mjaklitsch{at}partners.org
Study objectives: To determine the effect of age and type of surgery on long-term survival in patients with early-stage non-small cell lung cancer (NSCLC).
Design and patients: A total of 14,555 patients who were 
20 years of age with stage I or II primary NSCLC and had been registered in the Surveillance, Epidemiology, and End Results Database from 1992 to 1997 were analyzed. Age was grouped into the following three categories: < 65 years (n = 5,057; 35%); 65 to 74 years (n = 6,073; 42%); and 75 years (n = 3,425; 23%). Log-rank tests and Cox regression models were used for crude and adjusted survival analyses.
Measurements and results: A total of 8,080 men (55%) and 6,475 women (mean [± SD] age, 67.3 ± 9.8 years) with stage I NSCLC (83%) or stage II NSCLC were analyzed. Curative surgery was performed in 4,669 patients (92%) who were < 65 years of age (youngest), 5,219 patients (86%) who were 65 to 74 years of age (intermediate age), and 2,382 patients (70%) who were 75 years of age (elderly) [p < 0.0001]. Thirty percent of the elderly patients were denied surgery or were offered only palliative surgery, in contrast with 8% among the youngest patients (p < 0.0001). Limited resections increased from 8% in young patients to 17% in the elderly (p < 0.0001). Survival decreased with age. The median survival times were 71, 47, and 28 months, respectively, for patients < 65, 65 to 74, and 75 years of age (p < 0.0001). The results were unchanged after adjusting for sex, type of surgery, histology, and stage of disease. For the young patients, lobectomies conferred better survival times than limited resections after 2 years. However, there was no difference in survival between lobectomies and limited resections in terms of survival time for the elderly patients. The statistical difference in long-term survival between those patients undergoing lobectomies and those undergoing limited resections disappeared at 71 years.
Conclusions: Age is an independent predictor of postsurgical survival in NSCLC patients, even after adjustment for significant covariates. Curative surgery is performed less frequently in elderly patients. Among younger patients undergoing curative surgery, lobectomies are more commonly performed and confer a significant survival benefit over limited resections. This benefit, however, is not evident for patients > 71 years of age.
Key Words: elderly • limited resection • lobectomy • lung cancer • non-small cell lung cancer • surgery • Surveillance, Epidemiology, and End Results • survival
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