Outcomes of early stage lung cancer treatments in older patients: A SEER database analysis.

Abstract

7571 Background: Although the majority of lung cancer patients are over the age of 65, there are limited data on outcomes of treatment options for early stage lung cancer in older patients. Methods: Treatment and outcome data of stage I and II non-small cell lung cancer (NSCLC) patients were obtained from the Surveillance, Epidemiology and End Results (SEER) database. Treatment modalities included no treatment, surgery, radiation, and a combination of surgery and radiation. Patients were divided based on age groups into <65, 65-75, and >75 years old. Multivariate logistic regression was used to compare the likelihood of survival in the three age groups while controlling for gender and race. Results: A total of 10,763 patients diagnosed with stage I and II NSCLC between 1988 and 2007 within the SEER database were analyzed. The age distribution was as follows: <65 (n=3558), 65-75 years (n= 4454), >75 years (n=2751). Patients <65 years of age were more likely than those >75 years of age to be treated with surgery (72.5% vs. 53.5%, respectively; p = <0.0001). Patients >75 years of age were more often treated with radiation alone (23%) or no treatment (18.2%) as compared to those patients <65 (9% and 4.9%, respectively; p = <0.0001). Patients <65 years of age with stage I lung cancer had a statistically significant improved lung cancer-specific 5-year survival with surgery alone as compared to those 65-75 years and >75 years. Lung cancer specific mortality at 5 years was 19%, 26% and 30%, respectively; p= <0.0001. Similar results were seen in stage II patients. When stage I patients received radiation therapy, lung cancer-specific deaths at 5 years were not different between the three groups (66% vs. 63% vs. 66%, respectively; p=0.1263). The 5-year lung cancer- related mortality was lower in younger patients who received no treatment (51% in <65, 56% in 65-75, and 57% in >75 years old; p=0.006). Conclusions: Older patients treated surgically for stages I and II NSCLC have a lower lung cancer-specific survival when compared to younger patients. In contrast, there is no difference in lung cancer-specific survival for patients treated with radiation therapy. Hence, careful selection of older patients for surgical therapy of early stage NSCLC is warranted.