Outcomes After Surgical Management of Early-Stage Lung Cancer in Octogenarians: An In-Depth Analysis of a Nationally Representative Cohort

Ian C Bostock; Adam H Fox; Ralph C Ward; Kathryn E Engelhardt; Farhood Farjah; Chi-Fu Jeffrey Yang; Robert A Smith; Barry C Gibney; Gerard A Silvestri; American Cancer Society National Lung Cancer Roundtable (NLCRT)

doi:10.1016/j.jtho.2025.01.020

Outcomes After Surgical Management of Early-Stage Lung Cancer in Octogenarians: An In-Depth Analysis of a Nationally Representative Cohort

J Thorac Oncol. 2025 Jun;20(6):786-798. doi: 10.1016/j.jtho.2025.01.020. Epub 2025 Jan 28.

Authors

Ian C Bostock¹, Adam H Fox², Ralph C Ward³, Kathryn E Engelhardt¹, Farhood Farjah⁴, Chi-Fu Jeffrey Yang⁵, Robert A Smith⁶, Barry C Gibney¹, Gerard A Silvestri⁷; American Cancer Society National Lung Cancer Roundtable (NLCRT)

Affiliations

¹ Division of Cardiothoracic Surgery, Medical University of South Carolina, Charleston, South Carolina.
² Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina.
³ Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina.
⁴ Department of Cardiothoracic Surgery, University of Washington, Seattle, Washington.
⁵ Department of Cardiothoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
⁶ Prevention and Early Detection Department, American Cancer Society, Atlanta, Georgia.
⁷ Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina. Electronic address: silvestri@musc.edu.

PMID: 39884390
DOI: 10.1016/j.jtho.2025.01.020

Abstract

Introduction: As the United States population ages more octogenarians are undergoing surgical resection for lung cancer. We aimed to provide an updated and expanded assessment of age-related risks associated with surgical resections for early-stage NSCLC.

Methods: The Surveillance, Epidemiology, and End Results and Medicare databases were queried for stage IA NSCLC cases treated by surgery between 2006 and 2018. Analyses included generalized linear models for one-year mortality and Cox proportional hazards models for five-year survival.

Results: One-year all-cause mortality among 4061 octogenarians was more than double that of the youngest group (age: 65-69 y): 15.2% versus 7.3%, p value less than 0.001. Octogenarians were discharged to extended skilled nursing facility stays more than three times as often as the youngest group (19.9% versus 6.3%, p < 0.001). For those with skilled nursing facility duration greater than 30 days, there was a 36% greater one-year mortality risk compared with those discharged to home or home-health. In adjusted analyses, octogenarians had 62% greater one-year mortality risk compared with those aged below 80 years (risk ratio = 1.62, 95% confidence interval: 1.48-1.78). The risk of death within five years was 52% higher (hazard ratio = 1.52, 95% confidence interval: 1.42-1.62). Additional factors associated with one-year mortality included male sex, higher comorbidity burden, lower county median income, open approach, and sub-lobar resection.

Conclusions: This analysis provides an updated and expanded characterization of age-related outcomes on the basis of a large national cohort representative of elderly patients treated outside of clinical trials. Substantial gaps in survival and discharge disposition motivate further research and the development of interventions to help improve outcomes in older patients.

Keywords: Elderly; Lung cancer; Outcomes; Thoracic surgery.

MeSH terms

Aged
Aged, 80 and over
Carcinoma, Non-Small-Cell Lung* / mortality
Carcinoma, Non-Small-Cell Lung* / pathology
Carcinoma, Non-Small-Cell Lung* / surgery
Cohort Studies
Female
Humans
Lung Neoplasms* / mortality
Lung Neoplasms* / pathology
Lung Neoplasms* / surgery
Male
Neoplasm Staging
Pneumonectomy* / mortality
SEER Program
Survival Rate
United States / epidemiology