Mediastinal lymphadenectomy in elderly patients with non-small-cell lung cancer

• Published in: European journal of cardio-thoracic surgery Vol. 44; no. 1; pp. 88 - 92
• Main Authors: Rivera, Caroline, Falcoz, Pierre-Emmanuel, Rami-Porta, Ramón, Velly, Jean-François, Begueret, Hugues, Roques, Xavier, Dahan, Marcel, Jougon, Jacques
• Format: Journal Article
• Language: English
• Published: Germany Oxford University Press 01.07.2013
• Subjects: Aged; Carcinoma, Non-Small-Cell Lung - epidemiology; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - surgery; Case-Control Studies; Chi-Square Distribution; Female; Humans; Lung Neoplasms - epidemiology; Lung Neoplasms - pathology; Lung Neoplasms - surgery; Lymph Node Excision; Lymph Nodes - pathology; Lymph Nodes - surgery; Male; Mediastinum - pathology; Mediastinum - surgery; Middle Aged; Neoplasm Metastasis; Retrospective Studies; Lung cancer surgery; Elderly; Geriatric oncology; Lymph nodes
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezs586

OBJECTIVES The progressive ageing of the population is accompanied by an increasing incidence of cancer. Our objective was to compare mediastinal lymphadenectomy performed in the surgical treatment of non-small-cell lung cancer (NSCLC) patients between ≥70 and <70. METHODS We performed a retrospective single-centre case-control study, including 80 patients ≥70 years of age, surgically treated for NSCLC between January 2008 and December 2010, matched 1:1 to 80 younger controls on gender, American Society of Anesthesia score, performance status and histological subtype of the tumour. The number and type of dissected hilar/intrapulmonary and mediastinal lymph node stations as well as the number of resected lymph nodes were compared between the two age groups. RESULTS The type of pulmonary resection was significantly different between the two groups (P = 0.03): pneumonectomy 6% (n = 5) for patients ≥70 vs 12% (n = 10) for patients <70, lobectomy 85 (n = 68) vs 65% (n = 52), bilobectomy 1 (n = 1) vs 2% (n = 2) and sub-lobar resection 7 (n = 6) vs 20% (n = 16). There was no significant difference in type of mediastinal lymphadenectomy (radical vs sampling; P = 0.6). Elderly patients presented a more advanced N status of lymph node invasion than younger controls (P = 0.02). The number and type of dissected lymph node stations and the number of lymph nodes were not significantly different between the two age groups (P = 0.66 and 0.25, respectively). The mean number of metastatic lymph nodes was higher in patients ≥70 (2.3 vs 1.3 in patients <70; P = 0.002). Lymph node ratio between metastatic and resected lymph nodes was higher in elderly patients (0.11 vs 0.07 in younger controls; P = 0.009). CONCLUSIONS Lymph node involvement in surgically treated NSCLC was more significant in elderly patients ≥70 than in younger patients presenting comparable clinical and histopathological characteristics, and undergoing a similar lymphadenectomy.