Hisashi Saji1, Takahiko Ueno2, Hiroshige Nakamura3, Norihito Okumura4, Masanori Tsuchida5, Makoto Sonobe6, Takuro Miyazaki7, Keiju Aokage8, Masayuki Nakao9, Tomohiro Haruki3, Hiroyuki Ito10, Kazuhiko Kataoka11, Kazunori Okabe12, Kenji Tomizawa13, Kentaro Yoshimoto14, Hirotoshi Horio15, Kenji Sugio16, Yasuhisa Ode17, Motoshi Takao18, Morihito Okada19,20, Masayuki Chida19,21. 1. Department of Chest Surgery, St. Marianna University School of Medicine, Kanagawa, Japan. 2. Department of Medical Informatics, St. Marianna University School of Medicine, Kanagawa, Japan. 3. Division of General Thoracic Surgery, Tottori University Hospital, Tottori, Japan. 4. Department of Thoracic Surgery, Kurashiki Central Hospital, Okayama, Japan. 5. Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan. 6. Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 7. Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. 8. Division of Thoracic Surgery, Department of Thoracic Oncology, National Cancer Center Hospital East, Chiba, Japan. 9. Department of Thoracic Surgical Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan. 10. Department of Thoracic Surgery, Kanagawa Cancer Center, Kanagawa, Japan. 11. Department of Thoracic Surgery, Iwakuni Clinical Center, Iwakuni, Japan. 12. Division of Thoracic Surgery, Yamaguchi Ube Medical Center, Ube, Japan. 13. Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan. 14. Department of Thoracic Surgery, Minamikyusyu National Hospital, Kagoshima, Japan. 15. Department of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious Disease Center Komagome Hospital, Tokyo, Japan. 16. Department of Thoracic and Breast Surgery, Oita University, Oita, Japan. 17. Division of Thoracic Surgery, Shizuoka Cancer Center, Shizuoka, Japan. 18. Department of Thoracic and Cardiovascular Surgery, Mie University Graduate School of Medicine, Tsu, Japan. 19. Committee for Scientific Affairs, The Japanese Association for Thoracic Surgery, Tokyo, Japan. 20. Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, Japan. 21. Department of Thoracic Surgery, Dokkyo Medical University, Tochigi, Japan.
Abstract
OBJECTIVES: Although some retrospective studies have reported clinicopathological scoring systems for predicting postoperative complications and survival outcomes for elderly lung cancer patients, optimized scoring systems remain controversial. METHODS: The Japanese Association for Chest Surgery (JACS) conducted a nationwide multicentre prospective cohort and enrolled a total of 1019 octogenarians with medically operable lung cancer. Details of the clinical factors, comorbidities and comprehensive geriatric assessment were recorded for 895 patients to develop a comprehensive risk scoring (RS) system capable of predicting severe complications. RESULTS: Operative (30 days) and hospital mortality rates were 1.0% and 1.6%, respectively. Complications were observed in 308 (34%) patients, of whom 81 (8.4%) had Grade 3-4 severe complications. Pneumonia was the most common severe complication, observed in 27 (3.0%) patients. Five predictive factors, gender, comprehensive geriatric assessment75: memory and Simplified Comorbidity Score (SCS): diabetes mellitus, albumin and percentage vital capacity, were identified as independent predictive factors for severe postoperative complications (odds ratio = 2.73, 1.86, 1.54, 1.66 and 1.61, respectively) through univariate and multivariate analyses. A 5-fold cross-validation was performed as an internal validation to reconfirm these 5 predictive factors (average area under the curve 0.70). We developed a simplified RS system as follows: RS = 3 (gender: male) + 2 (comprehensive geriatric assessment 75: memory: yes) + 2 (albumin: <3.8 ng/ml) + 1 (percentage vital capacity: ≤90) + 1 (SCS: diabetes mellitus: yes). CONCLUSIONS: The current series shows that octogenarians can be successfully treated for lung cancer with surgical resection with an acceptable rate of severe complications and mortality. We propose a simplified RS system to predict severe complications in octogenarian patients with medically operative lung cancer. Trial Registration Number: JACS1303 (UMIN000016756).
OBJECTIVES: Although some retrospective studies have reported clinicopathological scoring systems for predicting postoperative complications and survival outcomes for elderly lung cancerpatients, optimized scoring systems remain controversial. METHODS: The Japanese Association for Chest Surgery (JACS) conducted a nationwide multicentre prospective cohort and enrolled a total of 1019 octogenarians with medically operable lung cancer. Details of the clinical factors, comorbidities and comprehensive geriatric assessment were recorded for 895 patients to develop a comprehensive risk scoring (RS) system capable of predicting severe complications. RESULTS: Operative (30 days) and hospital mortality rates were 1.0% and 1.6%, respectively. Complications were observed in 308 (34%) patients, of whom 81 (8.4%) had Grade 3-4 severe complications. Pneumonia was the most common severe complication, observed in 27 (3.0%) patients. Five predictive factors, gender, comprehensive geriatric assessment75: memory and Simplified Comorbidity Score (SCS): diabetes mellitus, albumin and percentage vital capacity, were identified as independent predictive factors for severe postoperative complications (odds ratio = 2.73, 1.86, 1.54, 1.66 and 1.61, respectively) through univariate and multivariate analyses. A 5-fold cross-validation was performed as an internal validation to reconfirm these 5 predictive factors (average area under the curve 0.70). We developed a simplified RS system as follows: RS = 3 (gender: male) + 2 (comprehensive geriatric assessment 75: memory: yes) + 2 (albumin: <3.8 ng/ml) + 1 (percentage vital capacity: ≤90) + 1 (SCS: diabetes mellitus: yes). CONCLUSIONS: The current series shows that octogenarians can be successfully treated for lung cancer with surgical resection with an acceptable rate of severe complications and mortality. We propose a simplified RS system to predict severe complications in octogenarian patients with medically operative lung cancer. Trial Registration Number: JACS1303 (UMIN000016756).