Impact of increasing age on cause-specific mortality and morbidity in patients with stage I non-small-cell lung cancer: A competing risks analysis Journal Article


Authors: Eguchi, T.; Bains, S.; Lee, M. C.; Tan, K. S.; Hristov, B.; Buitrago, D. H.; Bains, M. S.; Downey, R. J.; Huang, J.; Isbell, J. M.; Park, B. J.; Rusch, V. W.; Jones, D. R.; Adusumilli, P. S.
Article Title: Impact of increasing age on cause-specific mortality and morbidity in patients with stage I non-small-cell lung cancer: A competing risks analysis
Abstract: Purpose: To perform competing risks analysis and determine short- and long-term cancer- and noncancer-specific mortality and morbidity in patients who had undergone resection for stage I non-small-cell lung cancer (NSCLC). Patients and Methods: Of 5,371 consecutive patients who had undergone curative-intent resection of primary lung cancer at our institution (2000 to 2011), 2,186 with pathologic stage I NSCLC were included in the analysis. All preoperative clinical variables known to affect outcomes were included in the analysis, specifically, Charlson comorbidity index, predicted postoperative (ppo) diffusing capacity of the lung for carbon monoxide, and ppo forced expiratory volume in 1 second. Cause-specific mortality analysis was performed with competing risks analysis. Results: Of 2,186 patients, 1,532 (70.1%) were ≥ 65 years of age, including 638 (29.2%) ≥ 75 years of age. In patients < 65, 65 to 74, and ≥ 75 years of age, 5-year lung cancer-specific cumulative incidence of death (CID) was 7.5%, 10.7%, and 13.2%, respectively (overall, 10.4%); noncancer-specific CID was 1.8%, 4.9%, and 9.0%, respectively (overall, 5.3%). In patients ≥ 65 years of age, for up to 2.5 years after resection, noncancer-specific CID was higher than lung cancer-specific CID; the higher noncancer-specific, early-phase mortality was enhanced in patients ≥ 75 years of age than in those 65 to 74 years of age. Multivariable analysis showed that low ppo diffusing capacity of lung for carbon monoxide was an independent predictor of severe morbidity (P < .001), 1-year mortality (P < .001), and noncancer-specific mortality (P < .001), whereas low ppo forced expiratory volume in 1 second was an independent predictor of lung cancer-specific mortality (P = .002). Conclusion: In patients who undergo curative-intent resection of stage I NSCLC, noncancer-specific mortality is a significant competing event, with an increasing impact as patient age increases. © 2016 by American Society of Clinical Oncology.
Journal Title: Journal of Clinical Oncology
Volume: 35
Issue: 3
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2017-01-20
Start Page: 281
End Page: 290
Language: English
DOI: 10.1200/jco.2016.69.0834
PROVIDER: scopus
PUBMED: 28095268
PMCID: PMC5456376
DOI/URL:
Notes: Article -- Export Date: 2 February 2017 -- Source: Scopus
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MSK Authors
  1. Valerie W Rusch
    638 Rusch
  2. James Huang
    118 Huang
  3. Bernard J Park
    151 Park
  4. Robert J Downey
    198 Downey
  5. Manjit S Bains
    219 Bains
  6. Sarina Bains
    18 Bains
  7. Ming-Ching Lee
    6 Lee
  8. David Randolph Jones
    150 Jones
  9. Takashi   Eguchi
    56 Eguchi
  10. Kay See   Tan
    68 Tan
  11. James Michael Isbell
    26 Isbell