Are postoperative consequences of neoadjuvant chemotherapy for non-small cell lung cancer more severe in elderly patients?

Objectives: The purpose of this study was to assess the postoperative morbidity of patients >= 75 years with non-small cell lung cancer (NSCLC) who underwent neoadjuvant chemotherapy, comparing them to younger patients. Methods: We performed a case-control study over a 5-year period using Epithor, the French Society of Thoracic and Cardiovascular Surgery database, including to date more than 160,000 procedures from 103 institutions. We collected prospectively the data concerning 1510 patients with NSCLC who underwent preoperative chemotherapy, from January 2005 to December 2009. In order to compare patients with similar characteristics, we matched the 81 patients >= 75 to 81 controls (<75) for gender, American Society of Anesthesia (ASA) score, Performance Status (PS), Forced Expiratory Volume (FEV1) and histological subtype of the tumor. The patients of the control group were randomized within the 1429 patients <75 included. Lung cancer surgical treatment, post-operative morbidity and mortality rates, and length of stay (LOS) were compared between the two age groups. Results: There was no significant difference in type of resection between the two groups (p = 0.07): pneumonectomy 15% (n = 12) for patients >= 75 vs 28% (n = 23) for younger patients, lobectomy 65% (n = 53) vs 54% (n = 44), bilobectomy 14% (n = 11) vs 6% (n = 5) and sub-lobar resection 4% (n = 3) for the two groups. There was no significant difference in type of mediastinal lymphadenectomy (p = 0.48) between the two age groups. Elderly patients presented a more important number of postoperative complications (p = 0.04) and these ones were more severe (p = 0.03). There was no significant difference in postoperative mortality with 30-day mortality: 4.9%, n = 4, versus 2.5%, n = 2, (p = 0.83); 60-day mortality: 6.2%, n = 5, versus 2.5%, n = 2, (p = 0.61); and 90-day mortality was the same. Hospital LOS was longer for the elderly (14.9 days, CI95%[12.5;17.4] vs 11.9 days, CI95%[10.7;13.3], p < 0.001). Conclusion: Postoperative morbidity after neoadjuvant chemotherapy is more important in elderly patients. These data should be taken into account when considering the interest of preoperative treatment in elderly patients with resectable NSCLC. (C) 2011 Elsevier Ireland Ltd. All rights reserved.