Abstract
Objective: To compare the survival and risk of serious adverse events in older patients with stages II-IIIA non-small cell lung cancer treated with or without postoperative platinum based chemotherapy. Design: Observational cohort study. Setting: Cases of lung cancer in Surveillance Epidemiology and End Results registry linked to Medicare files, 1992-2005, and follow-up data to December 2007. Participants: 3324 patients aged more than 65 years with resected stages II-IIIA lung cancer. Main outcome measures: Primary outcome was overall survival and secondary outcome was the rate of serious adverse events among older patients treated with or without adjuvant chemotherapy. Results: Overall, 21% (n=684) of patients received platinum based chemotherapy. Analyses adjusted, stratified, or matched by propensity scores showed that chemotherapy was associated with improved survival (hazard ratio range 0.78-0.81). The beneficial effect of chemotherapy was also observed among patients treated with radiation therapy (0.75-0.77) or without radiation therapy (0.74-0.77); however, chemotherapy was not beneficial for patients aged 80 or more (1.32-1.46). Adjuvant chemotherapy was associated with an increased odds of serious adverse events (odds ratio 2.0, 95% confidence interval 1.5 to 2.6). Conclusions: Platinum based adjuvant chemotherapy is associated with reduced mortality and increased risk of serious adverse events in older patients with stages II-IIIA lung cancer. The magnitude of the benefit is similar to that observed in randomised controlled trials carried out among selected patients.
| Original language | English (US) |
|---|---|
| Article number | d4013 |
| Journal | BMJ (Online) |
| Volume | 343 |
| Issue number | 7817 |
| DOIs | |
| State | Published - Jul 30 2011 |
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Survival and risk of adverse events in older patients receiving postoperative adjuvant chemotherapy for resected stages II-IIIA lung cancer : Observational cohort study. / Wisnivesky, Juan P.; Smith, Cardinale B.; Packer, Stuart; Strauss, Gary M.; Lurslurchachai, Linda; Federman, Alex; Halm, Ethan A.
In: BMJ (Online), Vol. 343, No. 7817, d4013, 30.07.2011.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Survival and risk of adverse events in older patients receiving postoperative adjuvant chemotherapy for resected stages II-IIIA lung cancer
T2 - Observational cohort study
AU - Wisnivesky, Juan P.
AU - Smith, Cardinale B.
AU - Packer, Stuart
AU - Strauss, Gary M.
AU - Lurslurchachai, Linda
AU - Federman, Alex
AU - Halm, Ethan A.
PY - 2011/7/30
Y1 - 2011/7/30
N2 - Objective: To compare the survival and risk of serious adverse events in older patients with stages II-IIIA non-small cell lung cancer treated with or without postoperative platinum based chemotherapy. Design: Observational cohort study. Setting: Cases of lung cancer in Surveillance Epidemiology and End Results registry linked to Medicare files, 1992-2005, and follow-up data to December 2007. Participants: 3324 patients aged more than 65 years with resected stages II-IIIA lung cancer. Main outcome measures: Primary outcome was overall survival and secondary outcome was the rate of serious adverse events among older patients treated with or without adjuvant chemotherapy. Results: Overall, 21% (n=684) of patients received platinum based chemotherapy. Analyses adjusted, stratified, or matched by propensity scores showed that chemotherapy was associated with improved survival (hazard ratio range 0.78-0.81). The beneficial effect of chemotherapy was also observed among patients treated with radiation therapy (0.75-0.77) or without radiation therapy (0.74-0.77); however, chemotherapy was not beneficial for patients aged 80 or more (1.32-1.46). Adjuvant chemotherapy was associated with an increased odds of serious adverse events (odds ratio 2.0, 95% confidence interval 1.5 to 2.6). Conclusions: Platinum based adjuvant chemotherapy is associated with reduced mortality and increased risk of serious adverse events in older patients with stages II-IIIA lung cancer. The magnitude of the benefit is similar to that observed in randomised controlled trials carried out among selected patients.
AB - Objective: To compare the survival and risk of serious adverse events in older patients with stages II-IIIA non-small cell lung cancer treated with or without postoperative platinum based chemotherapy. Design: Observational cohort study. Setting: Cases of lung cancer in Surveillance Epidemiology and End Results registry linked to Medicare files, 1992-2005, and follow-up data to December 2007. Participants: 3324 patients aged more than 65 years with resected stages II-IIIA lung cancer. Main outcome measures: Primary outcome was overall survival and secondary outcome was the rate of serious adverse events among older patients treated with or without adjuvant chemotherapy. Results: Overall, 21% (n=684) of patients received platinum based chemotherapy. Analyses adjusted, stratified, or matched by propensity scores showed that chemotherapy was associated with improved survival (hazard ratio range 0.78-0.81). The beneficial effect of chemotherapy was also observed among patients treated with radiation therapy (0.75-0.77) or without radiation therapy (0.74-0.77); however, chemotherapy was not beneficial for patients aged 80 or more (1.32-1.46). Adjuvant chemotherapy was associated with an increased odds of serious adverse events (odds ratio 2.0, 95% confidence interval 1.5 to 2.6). Conclusions: Platinum based adjuvant chemotherapy is associated with reduced mortality and increased risk of serious adverse events in older patients with stages II-IIIA lung cancer. The magnitude of the benefit is similar to that observed in randomised controlled trials carried out among selected patients.
UR - http://www.scopus.com/inward/record.url?scp=84859005517&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84859005517&partnerID=8YFLogxK
U2 - 10.1136/bmj.d4013
DO - 10.1136/bmj.d4013
M3 - Article
C2 - 21757436
AN - SCOPUS:84859005517
VL - 343
JO - The BMJ
JF - The BMJ
SN - 0959-8146
IS - 7817
M1 - d4013
ER -