Non Small Cell Lung Cancer in the Elderly: Clinico-Pathologic, Management and Outcome Characteristics in Comparison to Younger Patients

Abstract

It is controversial whether non-small cell lung cancer (NSCLC) in the elderly constitutes a distinct clinico-biological entity compared to younger counterparts. As reported data are scant and discordant, we sought to analyze retrospectively the medical records of Hellenic NSCLC patients aged >70 years and compare them with those of age (70-45 years) and younger (<45 years) patients. Records were abstracted from the Hellenic Cooperative Oncology Group (HECOG) cancer registry database. Presentation, management and outcome data of 417 elderly patients aged ≥70, 1374 age 70-45 years old and 115 patients aged ≤45 years old with histologically confirmed NSCLC managed from 1989 until 2004 were retrieved and compared. Elderly patients differed significantly in terms of presence of symptoms (p<0.001), including thoracic pain(p=0.003), dyspnea (p<0.001), cough (p<0.001) and fatigue (p≥1), eastern Co-operative Oncology Group performance status (PS) 2-3 (p≥1), and histological type (more commonly diagnosed with squamous cell carcinoma (p<0.002) and less frequently with adenocarcinoma). Although elderly patients had significantly higher rates of PS 2-3, they had significantly better median time to disease progression (TTP) com-pared to the younger counterpart (6.4 versus 4.3 months p=0.047). Overall survival (OS) was not significantly different between elderly and young patients (median OS11.8 versus 11.5 months; p=0.6), but platinum-based chemotherapy and radiotherapy were variables associated favorably with TTP and survival in the elderly. this large retrospective series presents strong evidence that NSCLC constitutes a similar clinico-pathologic entity in elderly and young individuals with discretely differing biological behavior and that elderly symptomatic patients should be considered for effectiveanticancer treatment whenever possible.