Abstract
BackgroundOld age is an important factor that could affect the treatment of early-stage lung cancer. In this study, we evaluated the treatment patterns and outcomes of patients over the age of 80 years who had been diagnosed with early-stage lung cancer in real-world practice.MethodsElderly patients who were diagnosed with early-stage lung cancer between 2008 and 2016 were identified using claims data provided by the Health Insurance Review and Assessment Service. The proportion of patients who underwent surgical resection or stereotactic body radiation therapy (SBRT), practice pattern trends, and overall survival (OS) were analyzed from the population-based data.ResultsOver 9 years, 1,684 patients underwent surgical resection (74.9%) or SBRT (25.1%) as a localized treatment. From 2008 to 2016, the treatment modality changed: the percentage of patients who underwent surgical resection decreased from 90.6 to 71.4%, and those who underwent SBRT increased from 9.4 to 28.6%. The percentage of patients treated with SBRT increased over time (p < 0.001). The median OS was 56.4 months in the surgery group and 35.5 months in the SBRT group. The SBRT group showed worse OS compared with the surgery group (Adjusted hazard ratio, 1.44; 95% confidence interval, 1.21–1.72; p < 0.001).ConclusionChanges in local treatment patterns in elderly lung cancer patients were observed and SBRT increased its role in this population. Surgical resection or SBRT should be considered the treatment of choice in elderly patients with localized lung cancer. Further prospective studies are required to elucidate the benefits of surgery and SBRT.
Highlights
Old age is an important factor that could affect the treatment of early-stage lung cancer
This study evaluated the trends in practice patterns and survival outcomes over 9 years in patients 80 years and older diagnosed with early-stage lung cancer and compared the overall survival (OS) rates of those who underwent surgery and stereotactic body radiation therapy (SBRT)
The Health Insurance Review and Assessment service (HIRA) service provided the data after patient de-identification, in accordance with the Act on the Protection of Personal Information maintained by public agencies
Summary
Old age is an important factor that could affect the treatment of early-stage lung cancer. Lung cancer is the leading cause of cancer-related deaths in South Korea, the 5-year survival rate has increased from 11.3 to 25.1% [1]. Elderly patients (> 80 years old) with comorbidities do not receive surgery due to concerns about surgery-related mortality and morbidity [4,5,6]. Patients at this age often abandon the opportunity to cure early-stage non-small-cell lung cancer (NSCLC) due to the number of comorbidities, which increase proportionally with age [7, 8].
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