Analysis of Cause-Specific Mortality in Lung Cancer Surgery Older Than 80 Years: Japanese Multi-institutional Retrospective study

Haruaki Hino ¹, Takahiro Karasaki ², Yukihiro Yoshida ³, Takeshi Fukami ⁴, Atsushi Sano ⁵, Makoto Tanaka ⁶, Yoshiaki Furuhata ⁷, Kosuke Kashiwabara ⁸, Junji Ichinose ², Mitsuaki Kawashima ², Jun Nakajima ²

¹ Department of Thoracic Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology,, Tokyo, Japan; ² Department of Thoracic Surgery, The University of Tokyo Graduate School of Medicine, Tokyo, Japan; ³ Department of Thoracic Surgery, Asahi General Hospital, Asahi, Japan; ⁴ Department of Thoracic Surgery, National Hospital Organization Tokyo National Hospital, Kiyose, Japan; ⁵ Department of Thoracic Surgery, Chigasaki Municipal Hospital, Chigasaki, Japan; ⁶ Department of Thoracic Surgery, JR Tokyo General Hospital, Tokyo, Japan; ⁷ Department of Thoracic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan; ⁸ Department of Biostatistics, The University of Tokyo School of Public Health, Tokyo, Japan;

Date, time and location: 2018.05.26 08:30, Congress Hall, 2F–C

Abstract

OBJECTIVE

The aim of this study is to analyze the cause-specific death for lung cancer surgery older than 80 years from Japanese multi-institutional retrospective study.

METHODS

All patients older than 80 years were underwent radical surgery for primary lung cancer from January 1998 to December 2015 in 7 hospitals. Preoperative clinical date, surgical results, survival time were evaluated, and the significant risk factors for cancer-related and non-cancer related deaths were analyzed.

RESULTS

337 cases were included in this study. Median age was 82 (range 80-92), and male predominance was 68.1% (216 cases). Preoperative comorbidity was complicated in 61.4% (207 cases). Operations included 237 (70.3%) lobectomies, 66 (19.6%) partial resections, 28 (8.3%) segmentectomies, 5 (1.5%) bilobectomies, and 1 (0.3%) pneumonectomy. Postoperative complication and mortality were 119 (35.3%) and 7 (2.1%) respectively. Pathological staging I/II/III were 239/60/38. The number of die of cancer and die of non-cancer were 52 and 44 respectively. On univariate and multivariate analysis of Cox proportional hazards model, the risk factors for cancer-related death was pathological staging (p=0.002), in contrast, non-cancer related death were male gender (p=0.045), interstitial pneumonia (p<0.001), Glasgow Prognostic Score (p=0.02), and pathological staging (p=0.046), which were as same as for overall survival. On Fine and Gray competing risk regression analysis, cancer-related death were significantly related with limited resection (p=0.04) and pathological staging (p=0.004), in contrast, non-cancer related deaths were significantly related with male gender (p=0.046), coronary artery disease (p=0.02), interstitial pneumonia (p<0.001), and pathological staging (p=0.007).

CONCLUSIONS

The risk factors for cancer-related and non-cancer related deaths were different, therefore we should take in mind the results to decide the surgical indication and procedure, and follow in outpatient clinic for lung cancer patient older than 80 years.