Outcomes of lobectomy in ‘active’ octogenarians with clinical stage I non-small-cell lung cancer

Abstract

Introduction: In octogenarians with early stage of lung cancer, sublobar resection has been shown to be no inferior survival to lobectomy. However, some octogenarians remain physically and mentally active. Methods: We retrospectively studied 65 octogenarians who underwent curative resection for clinical stage I NSCLC (excluding adenocarcinoma in situ). All patients were assessed by cardiologists and underwent stair-climbing tests (five flights, 18 m) and cognitive function tests. Lobectomy was performed in patients who could climb 5 flights of stairs without stopping or oxygen desaturation of >4%. Results: The actuarial survival rate was 68.6% at 5 years, and the median survival time was 109.2 months. Forty-three patients met the criteria for lobectomy. As compared with sublobar resection, lobectomy was associated with significantly higher rates of overall survival (78.4% vs. 48.5%; p = 0.02) and disease-specific survival (88.4% vs. 61.7%; p = 0.02) at 5 years. On multivariate analysis, male sex (hazard ratio, 3.827; 1.382-10.596) and sublobar resection (2.261; 1.054-5.360) were independent risk factors for survival. Mental disorders occurred in 6 patients (9.2%), and their score on preoperative cognitive function tests was significantly lower than that of patients without mental disorders (22.7 vs. 26.0, p = 0.01). Conclusion: Outcomes of lobectomy are good in physically and mentally competent octogenarians.