Benefit of adjuvant chemotherapy after resection of stage II (T1-2N1M0) non-small cell lung cancer in elderly patients.
Abstract
BACKGROUND: We evaluated the use and efficacy of adjuvant chemotherapy after resection
of T1-2N1M0 non-small cell lung cancer (NSCLC) in elderly patients. METHODS: Factors
associated with the use of adjuvant chemotherapy in patients older than 65 years of
age who underwent surgical resection of T1-2N1M0 NSCLC without induction chemotherapy
or radiation in the Surveillance, Epidemiology, and End Results-Medicare database
from 1992 to 2006 were assessed using a multivariable logistic regression model that
included treatment, patient, tumor, and census tract characteristics. Overall survival
(OS) was analyzed using the Kaplan-Meier approach and inverse probability weight-adjusted
Cox proportional hazard models. RESULTS: Overall, 2,781 patients who underwent surgical
resection as the initial treatment for T1-2N1M0 NSCLC and survived at least 31 days
after surgery were identified, with adjuvant chemotherapy given to 784 patients (28.2 %).
Factors that predicted adjuvant chemotherapy use were younger age and higher T status.
The 5-year OS was significantly better for patients who received adjuvant chemotherapy
compared with patients not given adjuvant chemotherapy: 35.8 % (95 % confidence interval
[CI] 31.9-39.6) vs. 28.0 % (95 % CI 25.9-30.0) (p = 0.008). In the inverse probability
weight-adjusted Cox proportional hazard regression model, adjuvant chemotherapy use
predicted significantly improved survival (hazard ratio 0.84; 95 % CI 0.76-0.92; p = 0.0002).
CONCLUSIONS: Adjuvant chemotherapy after resection of T1-2N1M0 NSCLC is associated
with significantly improved survival in patients older than 65 years. These data can
be used to provide elderly patients with realistic expectations of the potential benefits
when considering adjuvant chemotherapy in this setting.
Type
Journal articleSubject
AgedAged, 80 and over
Carcinoma, Non-Small-Cell Lung
Chemotherapy, Adjuvant
Female
Humans
Lung Neoplasms
Male
Neoplasm Staging
Pneumonectomy
Retrospective Studies
SEER Program
Survival Analysis
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https://hdl.handle.net/10161/14822Published Version (Please cite this version)
10.1245/s10434-014-4056-0Publication Info
Berry, Mark F; Coleman, Brooke K; Curtis, Lesley H; Worni, Mathias; D'Amico, Thomas
A; & Akushevich, Igor (2015). Benefit of adjuvant chemotherapy after resection of stage II (T1-2N1M0) non-small
cell lung cancer in elderly patients. Ann Surg Oncol, 22(2). pp. 642-648. 10.1245/s10434-014-4056-0. Retrieved from https://hdl.handle.net/10161/14822.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Igor Akushevich
Research Professor in the Social Science Research Institute
Lesley H. Curtis
Professor in Population Health Sciences
Lesley H. Curtis is Professor in the Departments of Population Health Sciences and
Medicine in the Duke School of Medicine and was inaugural chair of the Department
of Population Health Sciences. A health services researcher by training, Dr. Curtis
is an expert in the use of health care and Medicare claims data for health services
and clinical outcomes research, and a leader in national data quality efforts. Dr.
Curtis has led the linkage of Medicare claims with seve
Thomas Anthony D'Amico
Gary Hock Distinguished Professor of Surgery
Lung Cancer 1.Role of molecular markers in the prognosis and therapy of lung cancer
2.Genomic analysis lung cancer mutations Esophageal Cancer 1.Role of molecular
markers in the prognosis and therapy of esophageal cancer 2.Genomic analysis esophageal
cancer mutations
Mathias Worni
Medical Instructor in the Department of Surgery
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