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Outcomes After Adjuvant Platinum-based Chemotherapy in Elderly NSCLC Patients with T4 Disease

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The postoperative management of elderly patients with T4, N0–1, M0 non–small cell lung cancer (NSCLC) remains controversial. The objective of this study was to evaluate the association of adjuvant chemotherapy with survival and toxicity among these patients.

Methods

Using surveillance, epidemiology and end results registry data linked to Medicare claims, we identified 389 elderly patients with resected T4, N0–1, M0 NSCLC diagnosed between 1992 and 2007. We compared survival of patients treated with and without platinum-based chemotherapy using a Cox regression adjusting for propensity scores for chemotherapy use and use of radiotherapy. We used logistic regression to assess the risk of adverse events in patients receiving chemotherapy.

Results

No benefit was noted in overall survival with adjuvant chemotherapy after PS adjustment for both N0 (hazard ratio 0.78, 95 % confidence interval 0.50–1.23) and N1 (hazard ratio 1.01, 95 % confidence interval 0.67–1.53) cancers. Patients receiving adjuvant chemotherapy experienced severe adverse events more frequently than patients who did not receive chemotherapy.

Conclusions

Use of adjuvant chemotherapy in elderly patients with T4, N0–1, M0 NSCLC was not associated with a survival advantage and was associated with higher rates of severe toxicity.

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References

  1. Detterbeck FC, Boffa DJ, Tanoue LT. The new lung cancer staging system. Chest. 2009;136:260–71.

    Article  PubMed  Google Scholar 

  2. Yang HX, Hou X, Lin P, et al. Survival and risk factors of surgically treated mediastinal invasion T4 non–small cell lung cancer. Ann Thorac Surg. 2009;88:372–8.

    Article  PubMed  Google Scholar 

  3. Yildizeli B, Dartevelle PG, Fadel E, et al. Results of primary surgery with T4 non–small cell lung cancer during a 25-year period in a single center: the benefit is worth the risk. Ann Thorac Surg. 2008;86:1065–75.

    Article  PubMed  Google Scholar 

  4. William WN Jr, Lin HY, Lee JJ, et al. Revisiting stage IIIB and IV non–small cell lung cancer: analysis of the surveillance, epidemiology, and end results data. Chest. 2009;136:701–9.

    Article  PubMed  Google Scholar 

  5. Dillman RO, Herndon J, Seagren SL, et al. Improved survival in stage III non-small-cell lung cancer: seven-year follow-up of Cancer and Leukemia Group B (CALGB) 8433 trial. J Natl Cancer Inst. 1996;88:1210–5.

    Article  PubMed  CAS  Google Scholar 

  6. Jett JR, Schild SE, Keith RL, Kesler KA. Treatment of non–small cell lung cancer, stage IIIB: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;132:266S–76S.

    Article  PubMed  Google Scholar 

  7. Chambers A, Routledge T, Bille A, Scarci M. Does surgery have a role in T4N0 and T4N1 lung cancer? Interact Cardiovasc Thorac Surg. 2010;11:473–9.

    Article  PubMed  Google Scholar 

  8. Roy MS, Donington JS. Management of locally advanced non small cell lung cancer from a surgical perspective. Curr Treat Options Oncol. 2007;8:1–14.

    Article  PubMed  Google Scholar 

  9. Howlader N, Noone AM, Krapcho M, et al., editors. SEER Cancer Statistics Review, 1975--2009 (Vintage 2009 Populations). Bethesda, MD: National Cancer Institute; 2011. http://seer.cancer.gov/csr/1975_2009_pops09/, based on November 2011 SEER data submission, posted to the SEER web site, April 2012.

  10. Ries LAG, Eisner MP, Kosary CL, et al., editors. SEER Cancer Statistics Review, 1973--1996. Bethesda, MD: National Cancer Institute; 1999. http://seer.cancer.gov/Publications/CSR1973_1996/, 2001.

  11. Rajeswaran A, Trojan A, Burnand B, Giannelli M. Efficacy and side effects of cisplatin- and carboplatin-based doublet chemotherapeutic regimens versus non-platinum-based doublet chemotherapeutic regimens as first line treatment of metastatic non–small cell lung carcinoma: a systematic review of randomized controlled trials. Lung Cancer. 2008;59:1–11.

    Article  PubMed  Google Scholar 

  12. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45:613–9.

    Article  PubMed  CAS  Google Scholar 

  13. Locher JL, Kilgore ML, Morrisey MA, Ritchie CS. Patterns and predictors of home health and hospice use by older adults with cancer. J Am Geriatr Soc. 2006;54:1206–11.

    Article  PubMed  Google Scholar 

  14. Iezzoni LI, Daley J, Heeren T, et al. Identifying complications of care using administrative data. Med Care. 1994;32:700–15.

    Article  PubMed  CAS  Google Scholar 

  15. Shapiro M, Swanson SJ, Wright CD, et al. Predictors of major morbidity and mortality after pneumonectomy utilizing the Society for Thoracic Surgeons General Thoracic Surgery database. Ann Thorac Surg. 2010;90:927–34.

    Article  PubMed  Google Scholar 

  16. Virnig BA, Warren JL, Cooper GS, et al. Studying radiation therapy using SEER–Medicare-linked data. Med Care. 2002;40:IV-49–54.

    Google Scholar 

  17. Du XL, Osborne C, Goodwin JS. Population-based assessment of hospitalizations for toxicity from chemotherapy in older women with breast cancer. J Clin Oncol. 2002;20:4636–42.

    Article  PubMed  Google Scholar 

  18. Wei L, Lin D, Weissfeld L. Regression analysis of multivariate incomplete failure time data by modeling marginal distributions. J Am Stat Assoc. 1989;84:1065–3.

    Article  Google Scholar 

  19. Arriagada R, Bergman B, Dunant A, et al. Cisplatin-based adjuvant chemotherapy in patients with completely resected non-small-cell lung cancer. N Engl J Med. 2004;350:351–60.

    Article  PubMed  Google Scholar 

  20. Pignon JP, Tribodet H, Scagliotti GV, et al. Lung adjuvant cisplatin evaluation: a pooled analysis by the LACE Collaborative Group. J Clin Oncol. 2008;26:3552–9.

    Article  PubMed  Google Scholar 

  21. Arriagada R, Auperin A, Burdett S, et al. Adjuvant chemotherapy, with or without postoperative radiotherapy, in operable non-small-cell lung cancer: two meta-analyses of individual patient data. Lancet. 2010;375:1267–77.

    Article  PubMed  CAS  Google Scholar 

  22. Osaki T, Sugio K, Hanagiri T, et al. Survival and prognostic factors of surgically resected T4 non–small cell lung cancer. Ann Thorac Surg. 2003;75:1745–51.

    Article  PubMed  Google Scholar 

  23. Bernard A, Bouchot O, Hagry O, Favre JP. Risk analysis and long-term survival in patients undergoing resection of T4 lung cancer. Eur J Cardiothorac Surg. 2001;20:344–9.

    Article  PubMed  CAS  Google Scholar 

  24. Farjah F, Wood DE, Varghese TK Jr, et al. Trends in the operative management and outcomes of T4 lung cancer. Ann Thorac Surg. 2008;86:368–74.

    Article  PubMed  Google Scholar 

  25. Non–Small Cell Lung Cancer Collaborative Group. Chemotherapy in non–small cell lung cancer: a meta-analysis using updated data on individual patients from 52 randomised clinical trials. BMJ. 1995;311:899–909.

    Google Scholar 

  26. Rao J, Sayeed RA, Tomaszek S, et al. Prognostic factors in resected satellite-nodule T4 non–small cell lung cancer. Ann Thorac Surg. 2007;84:934–8.

    Article  PubMed  Google Scholar 

  27. Wisnivesky JP, Smith CB, Packer S, et al. Survival and risk of adverse events in older patients receiving postoperative adjuvant chemotherapy for resected stages II–IIIA lung cancer: observational cohort study. BMJ. 2011;343: d4013.

    Article  PubMed  Google Scholar 

  28. Maione P, Rossi A, Sacco PC, et al. Treating advanced non–small cell lung cancer in the elderly. Ther Adv Med Oncol. 2010;2:251–60.

    Article  PubMed  CAS  Google Scholar 

  29. Wisnivesky JP, Halm E, Bonomi M, et al. Effectiveness of radiation therapy for elderly patients with unresected stage I and II non–small cell lung cancer. Am J Respir Crit Care Med. 2010;181:264–9.

    Article  PubMed  Google Scholar 

  30. Pepe C, Hasan B, Winton TL, et al. Adjuvant vinorelbine and cisplatin in elderly patients: National Cancer Institute of Canada and Intergroup Study JBR.10. J Clin Oncol. 2007;25:1553–61.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

This study was supported by the National Center for Research Resources (KL2RR029885 to K.S.) as well as the National Cancer Institute (5R01CA131348-3).

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Authors and Affiliations

  1. Division of General Internal Medicine, Mount Sinai School of Medicine, New York, NY, USA

    Keith Sigel MD, MPH, Grace Mhango MPH & Juan Wisnivesky MD, DrPH

  2. Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA

    Jessica Cohen MD

  3. Departments of Internal Medicine and Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Ethan A. Halm MD, MPH

  4. Department of Preventive Medicine, Mount Sinai School of Medicine, New York, NY, USA

    John Mandeli PhD

  5. Division of Hematology–Oncology, Tufts University School of Medicine, Boston, MA, USA

    Gary Strauss MD, MPH

  6. Division of Pulmonary and Critical Care Medicine, Mount Sinai School of Medicine, New York, NY, USA

    Juan Wisnivesky MD, DrPH

Authors
  1. Keith Sigel MD, MPH
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  2. Grace Mhango MPH
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  3. Jessica Cohen MD
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  4. Ethan A. Halm MD, MPH
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  5. John Mandeli PhD
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  6. Gary Strauss MD, MPH
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  7. Juan Wisnivesky MD, DrPH
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Corresponding author

Correspondence to Keith Sigel MD, MPH.

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Sigel, K., Mhango, G., Cohen, J. et al. Outcomes After Adjuvant Platinum-based Chemotherapy in Elderly NSCLC Patients with T4 Disease. Ann Surg Oncol 20, 1013–1019 (2013). https://doi.org/10.1245/s10434-012-2717-4

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  • DOI: https://doi.org/10.1245/s10434-012-2717-4

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