Older patients more likely to die from cancer-related diseases than younger with stage IA non-small cell lung cancer: a SEER database analysis

Haibo Ma; Di Yao; Jiwei Cheng; Wei Wang; Baoxing Liu; Yongkui Yu; Wenqun Xing; Jianjun Qin

doi:10.21037/jtd-22-505

Older patients more likely to die from cancer-related diseases than younger with stage IA non-small cell lung cancer: a SEER database analysis

J Thorac Dis. 2022 Jun;14(6):2178-2186. doi: 10.21037/jtd-22-505.

Authors

Haibo Ma¹, Di Yao², Jiwei Cheng¹, Wei Wang¹, Baoxing Liu¹, Yongkui Yu¹, Wenqun Xing¹, Jianjun Qin³

Affiliations

¹ Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.
² Information Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
³ Department of Thoracic Surgery, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China.

Abstract

Background: Various reports showed some conflicting data on survival at different ages. This study aimed to investigate the main cause of death in older patients with lung cancer and to perform a comparison with younger patients in order to observe the differences between these two cohorts.

Methods: Outcomes of patients with stage IA non-small cell lung cancer (NSCLC) ≤3 cm who underwent lobectomy without induction therapy in the Surveillance, Epidemiology, and End Results-18 (SEER-18; January 2004 to December 2016) database were evaluated using multivariable Cox proportional hazards modeling and propensity score-matched analysis.

Results: A total of 16,672 eligible NSCLC cases were found in the SEER database. The number of patients aged ≤60, 61-70, and ≥71 years was 3,930, 6,391, and 6,351, respectively. Among these patient groups, 527 (13.4%), 1,018 (15.9%), and 1,235 (19.4%) died of lung cancer during follow-up, while 357 (9.1%), 964 (15.1%) and 1,579 (25.2%) died of non-lung cancer diseases, respectively. The overall survival (OS) and lung cancer-specific survival (LCSS) rates of younger patients showed a significant survival advantage over older patients. After propensity-score matching (PSM) of patients aged ≤60 and ≥71 years using a ratio of 1:1, we found that 403 (12.9%) and 584 (18.7%) patients in the ≤60 and ≥71 years age groups died of lung cancer, respectively. The OS and LCSS rates of younger patients still exhibited a significant survival advantage over older patients.

Conclusions: Older patients with stage IA NSCLC have a worse prognosis compared with younger patients. Also, cancer-related causes were more frequent in older patients than non-cancer-related causes.

Keywords: IA non-small cell lung cancer (IA NSCLC); cancer-related; non-cancer-related; older patients.