Benefit of adjuvant chemotherapy after resection of stage II (T1-2N1M0) non-small cell lung cancer in elderly patients.

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2015-02

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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.

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10.1245/s10434-014-4056-0

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Berry, Mark F, Brooke K Coleman, Lesley H Curtis, Mathias Worni, Thomas A D'Amico and Igor Akushevich (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.

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Curtis

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 several large clinical registries and epidemiological cohort studies including the Framingham Heart Study and the Cardiovascular Health Study. Dr. Curtis currently serves as a senior policy advisor at the Food and Drug Administration supporting the Agency’s evidence generation initiative, and is co-PI of the NIH Pragmatic Trials Collaboratory, an NIH initiative to strengthen the national capacity for large-scale research studies embedded in health care delivery.

Areas of expertise: Health Services Research and Health Policy

 


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