Is surgery with curative intent feasible in old and very old patients with non-small cell lung cancer? – Experience of a certified lung cancer center over one decade

TL;DR

This study examines whether surgery for non-small cell lung cancer is feasible in elderly patients, finding that it is possible but with some age-related differences in outcomes.

Contribution

The study provides evidence that curative surgery for NSCLC is feasible in elderly patients, with comparable oncological outcomes despite age-related challenges.

Findings

Older patients had longer hospital stays and more postoperative cardiac arrhythmias.

Patients over 80 had significantly poorer overall survival compared to those aged 60–69.

Progression-free survival was not significantly associated with age.

Abstract

Non-small cell lung cancer (NSCLC) accounts for 80% of all lung cancers and, like most other cancers, is a disease of advanced age. This study analyzed the question of whether surgical treatment for non-small cell lung cancer (NSCLC) in elderly patients is acceptable in all operable stages with curative intent.

In this retrospective analysis, we used data of all NSCLC patients aged over 60 who underwent lobectomy at the Lung Cancer Centre Munich between 2011–2020 and divided them into four groups in ascending order of age. We performed Kaplan–Meier survival analysis and multivariate Cox regression to compare progression-free survival (PFS) and overall survival (OS) between the age groups. To compare numerical outcomes between the age groups we used analysis of variance (ANOVA), and Chi2-test for categorical outcomes.

Of 1680 patients undergoing lobectomy, 1221 met our inclusion criteria. It was found that the length of hospital stay increased with advanced age and was significantly longer in older patients (p < 0.001). Although the older patients had more comorbidities, only cardiac arrhythmias occurred significantly more often in the postoperative phase (p = 0.02). Kaplan–Meier survival analysis and multivariate Cox regression analysis showed significantly poorer OS for patients aged over 80 compared to patients aged between 60 to 69. PFS was not significantly associated with age.

Surgery with curative intent is feasible in old and very old patients with NSCLC and the oncological outcome is comparable. However, we recommend individual selection in view of patient age.

The online version contains supplementary material available at 10.1007/s00423-026-03995-7.

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