Is adjuvant chemotherapy for completely resected p-stage IA (>2 cm) and stage IB non-small-cell lung cancer beneficial for elderly patients? A large, retrospective cohort study based on real-world data from Japan-Reference-Cited by-同舟云学术

Is adjuvant chemotherapy for completely resected p-stage IA (>2 cm) and stage IB non-small-cell lung cancer beneficial for elderly patients? A large, retrospective cohort study based on real-world data from Japan

Published:2023-08-25 Issue:12 Volume:53 Page:1191-1200
ISSN:1465-3621
Container-title:Japanese Journal of Clinical Oncology
language:en
Short-container-title:

Author:

Adachi Hiroyuki¹²^ORCID,Saito Aya²,Shintani Yasushi³,Okami Jiro⁴,Ito Hiroyuki¹,Ohtsuka Takashi⁵⁶,Mori Takeshi⁷,Watanabe Shun-ichi⁸,Chida Masayuki⁹,Endo Shunsuke¹⁰,Nakanishi Ryoichi¹¹¹²,Kadokura Mitsutaka¹³,Suzuki Hidemi¹⁴¹⁵,Miyaoka Etsuo¹⁶,Yoshino Ichiro¹⁴¹⁵,Date Hiroshi¹⁷,Japanese Joint Committee of Lung Cancer Registry

Affiliation:

1. Department of Thoracic Surgery, Kanagawa Cancer Center , Yokohama, Japan

2. Department of Surgery, Yokohama City University , Yokohama, Japan

3. Department of General Thoracic Surgery, Osaka University Graduate School of Medicine , Suita, Japan

4. Department of General Thoracic Surgery, Osaka International Cancer Institute , Osaka, Japan

5. Division of Thoracic Surgery , Department of Surgery, , Tokyo, Japan

6. Jikei University School of Medicine , Department of Surgery, , Tokyo, Japan

7. Department of Thoracic Surgery, Japanese Red Cross Kumamoto Hospital , Kumamoto, Japan

8. Department of Thoracic Surgery, National Cancer Center Hospital , Tokyo, Japan

9. Department of General Thoracic Surgery, Dokkyo Medical University , Tochigi, Japan

10. Department of Thoracic Surgery, Jichi Medical School , Tochigi, Japan

11. Department of Oncology , Immunology and Surgery, , Nagoya, Japan

12. Nagoya City University Graduate School of Medical Sciences , Immunology and Surgery, , Nagoya, Japan

13. Respiratory Disease Center, Showa University Northern Yokohama Hospital , Yokohama, Japan

14. Department of General Thoracic Surgery , Graduate School of Medicine, , Chiba, Japan

15. Chiba University , Graduate School of Medicine, , Chiba, Japan

16. Department of Mathematics, Tokyo University of Science , Tokyo, Japan

17. Department of Thoracic Surgery, Kyoto University , Kyoto, Japan

Abstract

Abstract Objective The efficacy of tegafur-uracil as adjuvant chemotherapy for patients with completely resected stage I non-small-cell lung cancer is proven; however, its efficacy for elderly patients remains unclear. Herein, we evaluated the effectiveness of adjuvant chemotherapy for elderly patients with completely resected stage I non-small-cell lung cancer based on real-world Japanese data using propensity score matching. Methods This retrospective study extracted data from a nationwide registry study, performed in 2016, on patients ≥75 years who underwent lobectomy with mediastinal nodal dissection for non-small-cell lung cancer in 2010 and were diagnosed with p-stage IA (>2 cm) or stage IB non-small-cell lung cancer. We classified the 1294 patients into two groups—Group A, postoperative adjuvant chemotherapy (n = 295, 22.8%) and Group N, no adjuvant chemotherapy (n = 999, 77.2%)—and analyzed differences in postoperative overall survival between groups. Results Group A showed no advantage in overall survival over Group N as a whole (hazard ratio: 0.824 [95% confidence interval: 0.631–1.076]), in p-stage IA (hazard ratio: 0.617 [95% confidence interval: 0.330–1.156]) and in p-stage IB (hazard ratio: 0.806 [95% confidence interval: 0.597–1.088]) subsets. Even after propensity score matching, Group A showed no significant advantage in overall survival over Group N as a whole (hazard ratio: 0.975 [95% confidence interval: 0.688–1.381]), in p-stage IA (hazard ratio: 1.390 [95% confidence interval: 0.539–3.586]) and in p-stage IB (hazard ratio: 0.922 [95% confidence interval: 0.633–1.343]). Conclusions adjuvant chemotherapy for completely resected p-stage IA (>2 cm) and stage IB non-small-cell lung cancer showed no benefit for recommendation for elderly patients; considering the risk of adverse events, we do not recommend adjuvant chemotherapy for elderly patients.

Publisher

Oxford University Press (OUP)

Subject

Cancer Research,Radiology, Nuclear Medicine and imaging,Oncology,General Medicine

Link

https://academic.oup.com/jjco/article-pdf/53/12/1191/54060608/hyad116.pdf

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