# Surgical outcomes and quality of life in octogenarians with early-stage non-small cell lung cancer: a prospective cohort study

## TL;DR

This study shows that octogenarians with early-stage lung cancer can safely undergo surgery and maintain quality of life similar to younger patients.

## Contribution

The study provides new evidence on surgical safety and quality of life outcomes in octogenarians with early-stage NSCLC.

## Key findings

- Octogenarians had higher complication rates but similar long-term survival as younger patients.
- Physical and mental health scores improved by 12 months post-surgery in both age groups.
- Sublobar resections were more common in octogenarians compared to younger patients.

## Abstract

As life expectancy increases, more adults aged ≥80 years are diagnosed with early-stage lung cancer. Often these patients are excluded from screening programs and clinical trials due to concerns about comorbidities and surgical risk as evidence on surgical outcomes and quality of life (QoL) remains limited. We aimed to compare postoperative outcomes, survival, and QoL between octogenarians and younger patients undergoing surgery for Stage IA NSCLC.

We included patients with stage IA non-small cell lung cancer from the Mount Sinai Health System enrolled in the prospective Initiative for Early Lung Cancer Research on Treatment (IELCART) study. Octogenarians (80 years and older) were compared to younger patients in terms of clinical presentation, type of surgery, postoperative outcomes, and survival. Quality of life was assessed using physical and mental health scores at baseline and at 1, 6, and 12 months after surgery. Lung cancer–specific and overall survival were analyzed using Kaplan–Meier methods.

Among 884 patients, 114 (12.9%) were octogenarians. Compared to 770 younger patients, octogenarians had similar comorbidities but underwent more frequently sublobar resections [90/114 (78.9%) vs. 485/770 (62.4%), p = 0.030] and had higher complication rates [46/114 (40%) vs. 168/770 (22%), p < 0.0001], particularly cardiovascular. Intensive care unit admissions and readmissions were slightly more frequent. In both age groups, physical and mental health declined at two months but improved by twelve months, with no significant differences. Five-year overall- and lung cancer-specific survival rates were similar between octogenarians and younger patients (overall: 84.2% vs. 87.3%, lung cancer–specific survival: 94.4% vs. 94.5%).

Among octogenarians with early-stage NSCLC, surgical treatment was associated with favorable safety and long-term quality-of-life outcomes in carefully selected patients.

This study was supported by generous grants from the 10.13039/100000893Simons Foundation (International, Ltd.).