Advanced non-small cell lung cancer in the elderly: The impact of age and comorbidities on treatment modalities and patient prognosis

Objectives: Data on the treatment modalities and prognostic factors for elderly patients with advanced non-small cell lung cancer (NSCLC) remain limited. This study investigates the impact of age and comorbidities on treatment modalities and patient prognosis. Materials and Methods: From January 2004 to December 2008, patients aged >= 70 years old and diagnosed with stage IIIB or IV NSCLC were included retrospectively. Their clinical characteristics were reviewed and analyzed. Comorbidity status was evaluated using Charlson comorbidity index (CCI) and simplified comorbidity score (SCS). Results: A total of 576 patients were included in this analysis. Four hundred and nineteen patients (72.7%) received systemic therapy, including 182 (31.6%) patients who received chemotherapy, and 237(41.1%) patients who received epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI) as initial treatment. Patients aged >= 80 were less likely to receive chemotherapy as initial treatment than those aged 70-79 (12.3% vs. 40.9%, p < 0.001). There was no significant difference in proportion of chemotherapy between patients with high and low comorbidity score. Receipt of systemic therapy, male gender, PS >= 2, and histologic type were associated with a poorer prognosis. In the multivariate analysis, which included the comorbidity items of SCS, cigarette smoking (HR: 1.73,95% CI: 1.36-2.21), age >= 80 (HR: 1.30,95% CI: 1.01-1.67), and PS >= 2 (HR: 3.07, 95% CI: 2.37-3.98) were associated with a shorter survival period. Conclusion: Age may limit chemotherapy use for elderly patients with NSCLC. Cigarette smoking is an important independent prognostic factor for this particular population. (C) 2014 Elsevier Ltd. All rights reserved.