Abstract
Whether age has any impact on the risk of lymph node (LN) metastasis in patients with early-stage non-small cell lung cancer (NSCLC) remains controversial. Therefore, we aimed to objectively compare the risk of LN metastasis between elderly and young patients so as to justify for age-different extent of surgical resection for treating these patients. We retrospectively collected clinical data of patients undergoing lobectomy or segmentectomy with systematic hilar and mediastinal LN dissection for clinical stage IA peripheral NSCLC from January 2015 to December 2018. Both multivariate logistic regression analysis and propensity score-matched (PSM) analysis were applied to compare the risk of LN metastasis between elderly (>65 years old) and young (≤65 years old) patients. We finally included a total of 590 patients for analysis (142 elderly patients and 448 young patients). In the analysis of unmatched cohorts, young patients tended to have higher rates of hilar/intrapulmonary LN (13.4% VS 9.2%) and mediastinal LN metastasis (10.5% VS 6.3%) than elderly patients. In the multivariate analysis, age was found to be an independent predictor of both hilar/intrapulmonary (Odds ratio(OR) = 2.065, 95%confidence interval(CI): 1.049–4.064, P = 0.036) and mediastinal (OR = 2.400, 95%CI: 1.083–5.316, P = 0.031) LN metastasis. Moreover, in the analysis of well-matched cohorts generated by PSM analysis, young patients had significantly higher rates of hilar/intrapulmonary (18.8% VS 9.4%, P = 0.039) and mediastinal LN metastasis (17.1% VS 6.0%, P = 0.008) than elderly patients. Therefore, age remains to be an independent predictor of LN metastasis in early-stage NSCLC and age-different extent of surgical resection may be justified for these patients.
Highlights
Whether age has any impact on the risk of lymph node (LN) metastasis in patients with early-stage non-small cell lung cancer (NSCLC) remains controversial
It is of great value to compare the risk of LN metastasis between elderly and young patients with early-stage NSCLC so as to provide evidence justifying for age-different extent of surgical resection for elderly and young NSCLC patients
We set the following inclusion criteria for patient inclusion: 1) patients should undergo upfront lobectomy or segmentectomy with systematic lymph node (LN) dissection (SLND) without any preoperative therapy; 2) patients should be preoperatively evaluated with clinical stage IA disease without positive LNs on preoperative computed tomography (CT) scan(T1N0M0, tumor size ≤3 cm); 3) patients should have peripherally located lung cancer(defined as tumors in the outer one third of the hemithorax)14; 4) patients should be pathologically diagnosed as primary NSCLC
Summary
Whether age has any impact on the risk of lymph node (LN) metastasis in patients with early-stage non-small cell lung cancer (NSCLC) remains controversial. We retrospectively collected clinical data of patients undergoing lobectomy or segmentectomy with systematic hilar and mediastinal LN dissection for clinical stage IA peripheral NSCLC from January 2015 to December 2018 Both multivariate logistic regression analysis and propensity score-matched (PSM) analysis were applied to compare the risk of LN metastasis between elderly (>65 years old) and young (≤65 years old) patients. In this study, we aimed to draw an objective conclusion regarding www.nature.com/scientificreports the different risk of LN metastasis (both intrapulmonary/hilar and mediastinal LNs) between elderly and young patients by conducting both multivariate logistic regression analysis and propensity score-matched (PSM) analysis, so as to provide evidence for justifying age-different extent of surgical resection for elderly and young patients with early-stage NSCLC
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