TY - JOUR
T1 - Outcomes after adjuvant platinum-based chemotherapy in elderly NSCLC patients with T4 disease
AU - Sigel, Keith
AU - Mhango, Grace
AU - Cohen, Jessica
AU - Halm, Ethan A.
AU - Mandeli, John
AU - Strauss, Gary
AU - Wisnivesky, Juan
N1 - Funding Information:
ACKNOWLEDGMENT This study was supported by the National Center for Research Resources (KL2RR029885 to K.S.) as well as the National Cancer Institute (5R01CA131348-3).
PY - 2013/3
Y1 - 2013/3
N2 - Background: The postoperative management of elderly patients with T4, N0-1, M0 non-small cell lung cancer (NSCLC) remains controversial. The objective of this study was to evaluate the association of adjuvant chemotherapy with survival and toxicity among these patients. Methods: Using surveillance, epidemiology and end results registry data linked to Medicare claims, we identified 389 elderly patients with resected T4, N0-1, M0 NSCLC diagnosed between 1992 and 2007. We compared survival of patients treated with and without platinum-based chemotherapy using a Cox regression adjusting for propensity scores for chemotherapy use and use of radiotherapy. We used logistic regression to assess the risk of adverse events in patients receiving chemotherapy. Results: No benefit was noted in overall survival with adjuvant chemotherapy after PS adjustment for both N0 (hazard ratio 0.78, 95 % confidence interval 0.50-1.23) and N1 (hazard ratio 1.01, 95 % confidence interval 0.67-1.53) cancers. Patients receiving adjuvant chemotherapy experienced severe adverse events more frequently than patients who did not receive chemotherapy. Conclusions: Use of adjuvant chemotherapy in elderly patients with T4, N0-1, M0 NSCLC was not associated with a survival advantage and was associated with higher rates of severe toxicity.
AB - Background: The postoperative management of elderly patients with T4, N0-1, M0 non-small cell lung cancer (NSCLC) remains controversial. The objective of this study was to evaluate the association of adjuvant chemotherapy with survival and toxicity among these patients. Methods: Using surveillance, epidemiology and end results registry data linked to Medicare claims, we identified 389 elderly patients with resected T4, N0-1, M0 NSCLC diagnosed between 1992 and 2007. We compared survival of patients treated with and without platinum-based chemotherapy using a Cox regression adjusting for propensity scores for chemotherapy use and use of radiotherapy. We used logistic regression to assess the risk of adverse events in patients receiving chemotherapy. Results: No benefit was noted in overall survival with adjuvant chemotherapy after PS adjustment for both N0 (hazard ratio 0.78, 95 % confidence interval 0.50-1.23) and N1 (hazard ratio 1.01, 95 % confidence interval 0.67-1.53) cancers. Patients receiving adjuvant chemotherapy experienced severe adverse events more frequently than patients who did not receive chemotherapy. Conclusions: Use of adjuvant chemotherapy in elderly patients with T4, N0-1, M0 NSCLC was not associated with a survival advantage and was associated with higher rates of severe toxicity.
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U2 - 10.1245/s10434-012-2717-4
DO - 10.1245/s10434-012-2717-4
M3 - Article
C2 - 23115004
AN - SCOPUS:84875230401
SN - 1068-9265
VL - 20
SP - 1013
EP - 1019
JO - Annals of Surgical Oncology
JF - Annals of Surgical Oncology
IS - 3
ER -