Clinical Characteristics And Prognostic Factors Studies Of Elderly Patients With Non-Small Cell Lung Cancer

Objective: To investigate the clinical characteristics and prognostic factors ofnone-small cell lung cancer in elderly patients that who was admitted in the geriatricwards of PLA Hospital and to provide the reference for clinical treatment andprognosis assessments.Methods: A retrospective analysis were performed using the clinical data of154elderly patients with non-small cell lung cancer in geriatric wards of PLA Hospitalfrom Jan.1st2000to Dce.31st2009as well as and the records of follow-up visits onprognosis. Kaplan-Meier method was used to analyse the single factor and thenLog-rank inspection. COX model was used to analyse the multiariate factors.Results: The age of selected patients ranged from60to101years old, average at77.2±8.6years with a median age of78years old.44.2%of patients were older than80years. There were146cases of male patients in the study group.64.9%of patients’performance statues scored below2. The most common chief complaints onadmission were: positive in physical examination; cough/expectoration andhemoptysis. The most common comorbidites were found to: Coronary heart disease,hypertension, COPD, diabdtes mellitus, the second primary cancer andcerebrovascular diseases. All the cases were diagonised with biopsy, among which,40.3%received open sugery.. Pathologic types of adenocarcinoma were accounted for52.6%. Poorly differentiated cancer was accounted for26.6%.57.8%of patients’tumor size were≤3cm. Advanced cancer (phase IIIB+IV) was accounted for35.1%.83.1%patients accepted antineoplastic treatments. The survival time of the patientswas between0.1to128.2months and the median survival time was25.8months. Themdian progression-free survival time was13.8months. The cumulative survival ratesof1-year,3-year and5-year time were53.0%,40.0%and29.0%, respectively.. Coxregression indicated that the age, PS score, smoking, cancer related symtoms, serum albumin level, tumor size, stage of TNM, BAC and the operation were independentprognostic factors.For patients that received sugery treatment, lobectomy provide a significanthigher survival time when compaired with wedge resection (p=0.011). The survivaltime was similar between radical surgery and radical radiotherapy for paitients ofstageⅠ(p=0.111). Compared to palliative radiotherapy group（<50Gy）, radicalradiotherapy group（≥50Gy）had longer survival time(p=0.034). Compared withsurgery alone and adjuvant chemotherapy, no significant difference was observed inpatients who was in stage Ⅰ~ⅢA(p=0.142). For those patients with stage IIB-IVcarcinoma, chemotherapy alone was selected as the first line treatment which showeda significant higher survival time when compared to BSC (p=0.042), but not tosequential chemoradioetherapy. Most of our patients were tolerant to platinum-basedchemotherapy or4cycles of planned standard chemotherapy. A significant elongationof survival time was observed in patients received chemotherapy. However, the firstline target therapy could prolong the survival time in stage ⅢB~Ⅳ patients than BSC(p=0.010), no significant difference was observed when compaired to chemotherapy(p=0.111). With target therapy, patients with adenocarcinoma had longer survival timethat those of other pathological types of lung cancer(p=0.001). If response evaluationwas defined SD or PR, regardless of the treatment method, survival time wassignificant longer than PD.Conclusion:①Age, PS score, smoking, cancer related symtoms, serum albumin level,tumor size, stage of TNM, BAC and the operation were independent prognosticfactors.②No significant difference in the survival time of stage I pateints receivingradical surgery or and radiotherapy.③Surgery and adjuvant chemotherapy alone didnot improve the survival time of stageⅠ~ⅢA patients compared to other strategies.④First line chemotherapy and target therapy could improve the survival for stageⅢB~Ⅳpatients. Therefore, comprehensive assessments of the patients’ conditionsshould be carried out before selecting the optimal therapy for NSCL in the elderly.