Peri- and postoperative morbidity and mortality in elderly patients with non-small cell lung cancer: a matched-pair study

<bold>Background:</bold> Recent data of operative outcomes following surgery with curative intent for non-small cell lung cancer (NSCLC) suggest that morbidity and mortality are comparable amongst different age groups. <bold>Methods:</bold> We identified 2015 patients with postoperative stage IA to IIIA NSCLC who had undergone surgery with curative intent at a single specialized lung cancer center from January 2010 to December 2015. We assessed short-term operative outcomes as postoperative morbidity, length of hospital stay, 90-day mortality and long-term operative outcomes in a matched-pair cohort (n=454) including 227 elderly patients (≥ 75 years) and corresponding 227 younger patients. <bold>Results:</bold> The rate of postoperative complications was comparable amongst the age groups (42% in the elderly vs. 36%, p=0.163), as were the median length of hospital stay (14 days in elderly vs. 13 days, p=0.185) and the 90-day mortality (4% in the elderly vs. 2.2%, p=0.424). In the elderly ECOG ≥ 1 was associated with decreased overall survival (HR=2.15, CI 1.34-3.46), as were preoperative serum C-reactive protein / albumin ratio ≥ 0.3 (HR=1.95, CI 1.23-3.11) and elevated preoperative serum creatinine levels ≥ 1.1 mg/dl (HR=1.84, CI 1.15-2.95). In the younger cohort male sex (HR=2.26, CI 1.17-4.36), postoperative stage III disease (HR 4.61, CI 2.23-9.54) and preoperative anemia (HR 2.09, CI 1.10-3.96) were associated with decreased overall survival. <bold>Conclusions:</bold> Our data suggest that preoperative treatment decision-making in the elderly should primarily consider individual assessment of patients’ functional performance. Advanced age alone should not exclude patients from surgery for resectable NSCLC.