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. 2020 Feb 1;11(1):82-92.
doi: 10.14336/AD.2019.0414. eCollection 2020 Feb.

Metastasis Patterns and Prognosis of Octogenarians with NSCLC: A Population-based Study

Yu Gu  1   2 , Junhua Zhang  1   2 , Zhirui Zhou  1   2 , Di Liu  1   2 , Hongcheng Zhu  1   2 , Junmiao Wen  1   2 , Xinyan Xu  1   2 , Tianxiang Chen  3 , Min Fan  1   2
Affiliations

Metastasis Patterns and Prognosis of Octogenarians with NSCLC: A Population-based Study

Yu Gu et al. Aging Dis. .

Abstract

Non-small cell lung cancer (NSCLC) is the most common cancer and the leading cause of cancer-related deaths worldwide. Age at diagnosis of advanced NSCLC is much older, but studies describing the practice patterns for octogenarians with distant metastasis NSCLC are limited. A retrospective, population-based study using national representative data from the Surveillance, Epidemiology, and End Results (SEER) program was conducted to evaluate 34 882 NSCLC patients with extrathoracic metastases from 2010 to 2013. Patients were classified into three groups (older group: ≥80 yrs, middle-aged group: 60-79 yrs, and younger group: ≤59 yrs). The role of different age at diagnosis of NSCLC in metastasis patterns was investigated, and survival of different age groups of metastatic NSCLC was assessed. The analysis revealed that older patients were more likely to only have bone or liver metastasis (p< 0.001), but less likely to have brain only metastasis (p<0.001) and multiple metastatic sites (p< 0.001) than other two groups. Age at diagnosis was an independent risk factor for different metastasis types. Older group had the worst overall survival (p<0.001) and cancer-specific survival (p<0.001). Furthermore, older age patients with only bone metastasis had the best cancer specific survival (p<0.05) while younger patients with only brain metastasis had the best prognosis (p<0.001). Over 60% octogenarians with metastatic NSCLC did not receive anti-cancer therapy and had the highest rate of cancer deaths among all patients. Our results may help clinicians make positive decisions regarding personalized treatment of metastatic NSCLC in the elderly.

Keywords: NSCLC; age-related; cancer; lung; metastasis; octogenarian; prognosis.

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Conflict of interest statement

Conflict of interest The authors declare that they have no conflict of interest.

Figures

Figure 1.
Figure 1.
Distant metastatic patterns of different age groups. Metastasis patterns of adenocarcinoma (A) and non-adenocarcinoma (B) were analyzed. Different patterns of multiple metastatic sites of adenocarcinoma (C) and non- adenocarcinoma (D) were also analyzed.
Figure 2.
Figure 2.
Multivariable logistic regression analyses predicting different sites of metastasis in adenocarcinoma patients. (A) only bone metastasis; (B) only brain metastasis; (C) only liver metastasis; (D) multiple metastatic sites. Abbreviation: NOS= not otherwise specified.
Figure 3.
Figure 3.
Multivariable logistic regression analyses predicting different sites of metastasis in nonadenocarcinoma patients. (A) Only bone metastasis; (B) only brain metastasis; (C) only liver metastasis; (D) multiple metastatic sites. Abbreviation: NOS= not otherwise specified.
Figure 4.
Figure 4.
Kaplan-Meier curve of OS (A) and CSS(B) by age groups among NSCLC patients with extrathoracic metastases. Abbreviation: OS=overall survival, CSS=cancer-specific survival
Figure 5.
Figure 5.
Kaplan-Meier curve of OS and CSS according to metastasis sites in all (A-B), older (>79 yrs) (C-D), middle-aged (60-79 yrs) (E-F), and younger (<60 yrs) (G-H) patients with NSCLC. Abbreviation: OS=overall survival, CSS=cancer-specific survival.
Figure 6.
Figure 6.
Rates of cancer death for different metastasis sites by age group.
See this image and copyright information in PMC

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