Outcomes Based on Age in CALGB 140503 (Alliance): Lobar Versus Sublobar Resection for Peripheral Stage IA Non-small...

In CALGB trial 140503, sublobar resection was not inferior to lobar resection for T1aN0 (size ≤ 2 cm) non-small cell lung cancer (NSCLC) patients. This analysis compares the effect of age on outcomes with the 2 approaches.

Patients (N = 697) were categorized by age: < 65 years, 65 to 75 years, and > 75 years. Baseline characteristics, surgical approaches, pathological findings, disease-free survival (DFS), overall survival (OS), time to recurrence (TTR), grade ≥ 3 adverse events, and 90-day mortality were compared. Continuous variables were compared with the Kruskal-Wallis test; discrete variables were tested with either Χ² or Fisher's exact test. Survival outcomes were compared using the stratified log-rank test.

The age distribution was as follows: 254 patients < 65 years; 314 patients 65 to 75 years, and 129 patients > 75 years. Baseline characteristics were matched between the cohorts, except for smoking status (current tobacco use in 57.9%, 32.5%, and 27.9% of the < 65, 65 to 75, and > 75 cohorts; P ≤ .0001) and mean percent predicted FEV1 (82.4, 83.9, 87.9, respectively; P = .03). Patients > 75 who underwent lobar resection compared to patients aged < 65 had a lower DFS (hazard ratio [HR]: 1.67; 95% CI, 1.06-2.62, P = .03) and OS (HR: 2.73, 95% CI, 1.61-4.64, P < .001). Age and grade ≥ 3 adverse events and 90-day mortality were similar in both resection groups.

Older patients tolerated surgical resection, with adverse events and 90-day mortality similar to those of younger patients. Surgical resection for early-stage NSCLC should be offered to all appropriate patients.

gov number: NCT00499330.