Select octogenarians with stage IIIa non-small cell lung cancer can benefit from trimodality therapy

Abstract

Objectives: Currently, more than 36% of patients diagnosed with lung cancer are 75 years of age or older. Management of stage IIIA cancer is variable, especially for octogenarians who might not be offered surgery because of questionable benefit. In this study we investigated the outcomes of definitive chemoradiotherapy (CR) and trimodality therapy (TM) management (CR and surgery) for clinical stage IIIA non-small cell lung cancer (NSCLC) in patients 80 years of age or older.

Methods: The National Cancer Data Base was queried for stage IIIA NSCLC in patients 80 years of age or older between 2004 and 2015. Patients were divided according to treatment type: definitive CR and TM. Patient demographic characteristics, facility type, Charlson-Deyo score, final tumor pathology, and survival data were extracted. Univariate analysis was performed, followed by 3:1 propensity matching to analyze overall survival differences. Unadjusted and adjusted Kaplan-Meier survival analyses were performed.

Results: From the database, 6048 CR and 190 TM octogenarians were identified. Patients in the TM group were younger (82 years old [TM] vs 83 years old [CR]; P < .0001), more likely to be treated at an academic/research institution (36% [TM] vs 26% [CR]; P = .003), had greater proportion of adenocarcinoma (52% [TM] vs 34% [CR]; P < .001), and a smaller tumor size (38 mm [TM] vs 33 mm [CR]; P = .025). After 3:1 matching, the 5-year overall survival for the TM group was 29% (95% CI, 22%-38%) versus 15% (95% CI, 11%-20%) for the CR group.

Conclusions: Selected elderly patients with stage IIIa NSCLC can benefit from an aggressive TM approach.

Keywords: CR, chemoradiotherapy; NCDB, National Cancer Database; NSCLC; NSCLC, non–small cell lung cancer; TM, trimodality therapy; octogenarian; stage IIIa; trimodality therapy.

Graphical abstract

Propensity matched 5-year survival in octogenarians undergoing treatment for stage IIIa NSCLC.

Figure 1

Patient selection and matching: the National Cancer Database (NCDB) was queried for octogenarians who underwent treatment for stage IIIa non–small call lung cancer (NSCLC) between 2004 and 2014. The population was divided into groups on the basis of treatment type (CR vs TM) and then underwent propensity score-matching on the basis of included variables resulting in matched CR and TM groups. dx, Diagnosis; CD, Charlson–Deyo.

Figure 2

Kaplan–Meier overall 5-year survival stratified according to treatment modality. A, Unmatched Kaplan–Meier overall survival in a comparison of trimodality therapy (TM) and definitive chemoradiotherapy (CR), 29% TM (95% CI, 4%-22%) versus 11% CR (95% CI, 10%-12%); log rank P < .001. B, Matched Kaplan–Meier overall survival in a comparison of TM and definitive CR, 29% (95% CI, 22.2%-38.6%) versus 15% (95% CI, 11.3%-20.0%); log rank P < .001.

Figure 3

In a propensity-matched study of octogenarians with stage IIIa non–small cell lung cancer (NSCLC) from the National Cancer Database (NCDB), those who underwent trimodality therapy were shown to have improved survival compared with those who underwent definitive chemoradiotherapy (CRT). This suggests that age alone does not preclude aggressive management of these patients, and that careful patient selection is a key factor in this population. OS, Overall survival.

Figure E1

Display of covariate balance before and after propensity score-matching using a parsimonious model (C-statistic = 0.68). CD, Charlson–Deyo.