Tailoring Treatment for Elderly Lung Cancer Patients: Evaluating the Clinical Benefit of Surgery and Adjuvant Therapy

Abstract

Abstract Background Surgery and adjuvant therapy are still the primary treatments for lung cancer,however, there is a lack of clear treatment guidelines specifically tailored for elderly patients with lung cancer. The objective of our study is to evaluate the clinical benefit and impact of surgey and adjuvant therapy in elderly patients(i.e.,≥ 70 years old) with lung cancer. Methods Cases of elderly lung cancer were retrieved and obtained from the Surveillance, Epidemiology, and End Results (SEERs) database between 2010 and 2015. These cases were divided into surgery and no‑surgery group, and Propensity score matching (PSM) was utilized to balance the baseline characteristics between the two groups. Cox regression analysis was performed to identify independent prognostic factors. Overall survival (OS) and cancer‑specific survival (CSS) were compared by using the Kaplan-Meier method and log‑rank test. Results Our study enrolled a total of 38,359 patients, with 22,132(56.7%) in the surgery and 16,227(43.3%) in the no‑surgery group. After being matched at a 1:1 ratio by PSM, 9439 patients from each group were included. Among age-stratified analysis (70-74; 75-79; 80-84; ≥85), The 5-year OS rate was 90.6%, 56.3%, 28.1% and 12.5% respectively in the surgery group and was 90.6%, 56.3%, 28.1% and 12.5% respectively in the no-surgery group(all p<0.05); The 5-year CSS rate was 90.6%, 56.3%, 28.1% and 12.5% respectively in the surgery group and was 90.6%, 56.3%, 28.1% and 12.5% respectively in the no-surgery group (all p<0.05). After multivariate Cox regression analysis, adjuvant therapy was an independent prognostic factor for OS and CSS (all P < 0.05). Further study show among elderly lung cancer patients, postoperative radio-chemotherapy had no improvement to survival. Conclusion Among elderly patients(i.e.,≥ 70 years old), Surgical resection provided a significant overall survival benefit. However, adjuvant chemoradiotherapy may not provide survival benefits for postoperative elderly patients.