Surgical treatment for octogenarians with lung cancer: results from a population-based series of 124 patients

With the increasing life span in the Western world, the number of octogenarians with resectable, localized non-small cell lung cancer is increasing. Previous reports on the outcome of surgery for lung cancer in octogenarians were mainly derived from single institutions. In contrast, this study presents results for all hospitals in a region of 3 million inhabitants.

General data on all patients diagnosed with lung cancer in the period 1989 to 2004 were retrieved from the Amsterdam Cancer Registry. Incidence and type of treatment were tabulated and tested for significance with chi2 analysis. Survival was calculated using actuarial analysis. Absolute and relative survival for octogenarians relative to other age groups and relative to other treatment modalities in octogenarians with clinical stage I/II lung cancer was performed.

Non-small cell lung cancer was diagnosed in 1993 octogenarians (14% of all lung cancer patients). One hundred twenty-four patients (6%) underwent surgery. Five patients died within 30 days of surgery (4%). Relative survival after 1, 2, and 5 years was 83%, 69%, and 47%, respectively. These relative survival figures are comparable with other age groups. There was a survival benefit for surgical resection versus radiotherapy and other or no treatment (relative 5-year survival of 47% versus 3% and 0%, respectively).

Resection rates in octogenarians are low but satisfactory postoperative mortality and acceptable survival suggest that selection criteria should be adapted. Until effective alternative treatment becomes available, surgical resection, preceded by a thorough preoperative assessment, should be considered in the "old but fit" octogenarian.