Benefits of adjuvant chemotherapy in elderly patients with stage IB–IIIB non-small cell lung cancer: a propensity-matched analysis

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Abstract

Background

Adjuvant chemotherapy (ACT) is a well-recognized and well-established treatment for surgically resected non-small cell lung cancer (NSCLC), but its suitability for elderly patients remains controversial. Further investigation is warranted to guide ACT decisions in this demographic.

Methods

We extracted data from the Surveillance, Epidemiology, and End Results (SEER) database, focusing on patients aged 70 years or older who underwent surgical resection for stage IB, II, or III NSCLC as per the 7th edition of the American Joint Committee on Cancer staging system (AJCC 7th edition). Propensity score matching (PSM), Kaplan-Meier analysis, and Cox regression were employed for statistical analyses.

Results

There were 503 participants received ACT in this study of 2,000 patients aged 70 or older with stage IB–IIIB NSCLC who underwent surgical resection without preoperative chemotherapy. Overall, ACT did not significantly correlate with extended overall survival (OS) (P=0.07) compared to non-ACT. After 2:1 PSM, the matched cohort comprised 317 non-ACT and 206 ACT recipients. Post-PSM, the ACT group exhibited improved OS (P=0.044) compared to the non-ACT group. Cox regression analysis identified gender, primary tumor site, histologic grade, N stage, and ACT as independent predictors of OS (P<0.05). Subgroup analysis indicated amplified ACT benefits in individuals aged 70–79 years, male, with N1 stage, or those without radiotherapy.

Conclusions

ACT may confer benefits to elderly stage IB–IIIB NSCLC patients, particularly those aged 70–79 years, male, and with N1 stage.

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Most cited references 33

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Lung cancer

Alesha Thai, Benjamin Solomon, Lecia V. Sequist … (2021)

Lung cancer is one of the most frequently diagnosed cancers and the leading cause of cancer-related deaths worldwide with an estimated 2 million new cases and 1·76 million deaths per year. Substantial improvements in our understanding of disease biology, application of predictive biomarkers, and refinements in treatment have led to remarkable progress in the past two decades and transformed outcomes for many patients. This seminar provides an overview of advances in the screening, diagnosis, and treatment of non-small-cell lung cancer and small-cell lung cancer, with a particular focus on targeted therapies and immune checkpoint inhibitors.

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Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group.

Jean-Pierre Pignon, Hélène Tribodet, Giorgio Scagliotti … (2008)

Several recent trials have shown a significant overall survival (OS) benefit from postoperative cisplatin-based chemotherapy in patients with non-small-cell lung cancer (NSCLC). The aim of the Lung Adjuvant Cisplatin Evaluation was to identify treatment options associated with a higher benefit or groups of patients who particularly benefit from postoperative chemotherapy. Individual patient data were collected and pooled from the five largest trials (4,584 patients) of cisplatin-based chemotherapy in completely resected patients that were conducted after the 1995 NSCLC meta-analysis. The interactions between patient subgroups or treatment types and chemotherapy effect on OS were analyzed using hazard ratios (HRs) and log-rank tests stratified by trial. With a median follow-up time of 5.2 years, the overall HR of death was 0.89 (95% CI, 0.82 to 0.96; P = .005), corresponding to a 5-year absolute benefit of 5.4% from chemotherapy. There was no heterogeneity of chemotherapy effect among trials. The benefit varied with stage (test for trend, P = .04; HR for stage IA = 1.40; 95% CI, 0.95 to 2.06; HR for stage IB = 0.93; 95% CI, 0.78 to 1.10; HR for stage II = 0.83; 95% CI, 0.73 to 0.95; and HR for stage III = 0.83; 95% CI, 0.72 to 0.94). The effect of chemotherapy did not vary significantly (test for interaction, P = .11) with the associated drugs, including vinorelbine (HR = 0.80; 95% CI, 0.70 to 0.91), etoposide or vinca alkaloid (HR = 0.92; 95% CI, 0.80 to 1.07), or other (HR = 0.97; 95% CI, 0.84 to 1.13). Chemotherapy effect was higher in patients with better performance status. There was no interaction between chemotherapy effect and sex, age, histology, type of surgery, planned radiotherapy, or planned total dose of cisplatin. Postoperative cisplatin-based chemotherapy significantly improves survival in patients with NSCLC.

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NCCN Guidelines Insights: Non-Small Cell Lung Cancer, Version 2.2021.

David Ettinger, Douglas E Wood, Dara L. Aisner … (2021)

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Non-Small Cell Lung Cancer (NSCLC) address all aspects of management for NSCLC. These NCCN Guidelines Insights focus on recent updates to the NCCN Guidelines regarding targeted therapies, immunotherapies, and their respective biomarkers.

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Author and article information

Journal

Journal ID (nlm-ta): Transl Cancer Res

Journal ID (iso-abbrev): Transl Cancer Res

Journal ID (publisher-id): TCR

Title: Translational Cancer Research

Publisher: AME Publishing Company

ISSN (Print): 2218-676X

ISSN (Electronic): 2219-6803

Publication date (Electronic): 16 June 2024

Publication date (Print): 30 June 2024

Volume: 13

Issue: 6

Pages: 3003-3015

Affiliations

[1]deptDepartment of Thoracic Surgery, Zhongshan Hospital Qingpu Branch , Fudan University , Shanghai, China

Author notes

Contributions: (I) Conception and design: S Zhang, X Qin, X Xiao; (II) Administrative support: H Xia; (III) Provision of study materials or patients: S Zhang; (IV) Collection and assembly of data: S Zhang, X Qin; (V) Data analysis and interpretation: S Zhang, X Xiao; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

[#]

These authors contributed equally to this work.

Correspondence to: Shengchao Zhang, MD. Department of Thoracic Surgery, Zhongshan Hospital Qingpu Branch, Fudan University, 1158 East Parkway, Shanghai 201700, China. Email: zhang.shengchao@ 123456qphospital.com .

Author information

Shengchao Zhang https://orcid.org/0000-0002-0641-7857

Article

Publisher ID: tcr-13-06-3003

DOI: 10.21037/tcr-24-2

PMC ID: 11231765

SO-VID: ce0c4ea0-7d80-431c-a6d9-110570fd88f5

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Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0.

Benefits of adjuvant chemotherapy in elderly patients with stage IB–IIIB non-small cell lung cancer: a propensity-matched analysis

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Abstract

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Core Readings in Statistical Mediation Analysis

Most cited references 33

Lung cancer

Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group.

NCCN Guidelines Insights: Non-Small Cell Lung Cancer, Version 2.2021.

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