Abstract
Objective:
In CALGB trial 140503, sublobar resection was not inferior to lobar resection for T1aN0 (size ≤ 2 cm) non-small cell lung cancer (NSCLC) patients. This analysis compares the effect of age on outcomes with the two approaches.
Methods:
Patients (N=697) were categorized by age: <65 years, 65-75 years, and>75 years. Baseline characteristics, surgical approaches, pathological findings, disease-free survival (DFS), overall survival (OS), time to recurrence (TTR), grade ≥3 adverse events, and 90-day mortality were compared. Continuous variables were compared with the Kruskal-Wallis test; discrete variables were tested with either χ2 or Fisher’s exact test. Survival outcomes were compared using the stratified log-rank test.
Results:
The age distribution was as follows: 254 patients < 65 years; 314 patients 65-75 years, and 129 patients >75 years. Baseline characteristics were matched between the cohorts, except for smoking status (current tobacco use in 57.9%, 32.5%, and 27.9% of the <65, 65-75, and >75 cohorts; p=<.0001) and mean percent predicted FEV1 (82.4, 83.9, 87.9, respectively; p=0.03). Patients >75 who underwent lobar resection compared to patients aged <65 had a lower DFS [hazard ratio (HR): 1.67; 95% CI, 1.06 – 2.62, p=0.03] and OS (HR: 2.73, 95% CI, 1.61 – 4.64, p<0.001). Age and grade ≥3 adverse events and 90-day mortality were similar in both resection groups.
Conclusions:
Older patients tolerated surgical resection, with adverse events and 90-day mortality similar to those of younger patients. Surgical resection for early-stage NSCLC should be offered to all appropriate patients.
Keywords: Early-stage non-small cell lung cancer, surgery, age, lobectomy, sublobar resection
Introduction
Lung cancer is the most common malignancy and the leading cause of cancer-related death worldwide, accounting for approximately 2.48 million new cases and 1.8 million deaths in 2022.1 According to recent available estimates, 60% of patients with lung cancer are 65 years of age or older at diagnosis, making this a significant burden in older patients.2 Despite recent advances in the understanding of the biology of lung cancer, survival outcomes can be significantly improved. The 5-year survival of patients diagnosed with stage I non-small cell lung cancer is only 68.4% (74.9% in patients <65 years, and 65.3% in patients ≥65 years).3
Most evidence used to treat older patients with NSCLC is based on data from younger patients, due to the lack of high-quality evidence specific to older patients.4,5 Older patients are often not prescribed standard therapy despite evidence that older patients with good performance status respond to therapy just as well as young patients.6–8 Due to multiple competing causes of death, older patients often do not demonstrate a benefit in overall survival, even though they may have similar progression-free survival benefits as younger patients.9 Similar concerns are raised regarding the role of surgery in older patients. Although multiple studies have shown that older patients, including octogenarians, tolerate lung cancer surgery as well as younger patients,10,11 surgery is not routinely recommended for older patients.12,13
Cancer and Leukemia Group B (CALGB) 140503 was a randomized phase 3 study comparing disease-free survival following lobar resection versus sublobar resections in patients with peripheral stage IA (≤ 2 cm) non-small cell lung cancer (NSCLC).14 CALGB is now part of the Alliance for Clinical Trials in Oncology. In this study, 63% of participants were over 65 years old, and 18% were over 75 years old. This retrospective post hoc analysis of the CALGB 140503 trial was conducted to evaluate the effect of age on surgical outcomes following both lobar and sublobar resections.
Patients and Methods
Details related to patient eligibility and trial design are available in the primary publication14. This was a secondary analysis of the primary trial and hence did not need a specific IRB approval. The primary trial protocol was approved by the CALGB/Alliance central institutional review board and the respective IRB at each participating institution. Each participant signed an IRB-approved, protocol-specific informed consent document in accordance with federal and institutional guidelines. Patients were categorized into three groups based on age at registration: <65 years, 65-75 years, and >75 years. Baseline characteristics, surgical approaches, pathological findings, disease-free survival (DFS), overall survival (OS), time to recurrence (TTR), ≥grade 3 or higher adverse events (AEs), and 90-day mortality were compared.
Statistical Analysis
This post hoc analysis was based on the intent-to-treat (ITT) population. Differences in descriptive features were summarized through the Kruskal-Wallis test for continuous variables and the chi-square test for categorical variables, unless expected counts were less than 5, in which case Fisher’s exact test was used. Disease-free survival was defined as the time between randomization and disease recurrence or death from any cause, whichever occurred first. Overall survival was defined as the time between randomization and death from any cause. Time to recurrence was defined as the time from randomization to first evidence of disease recurrence, with censoring for patients who died prior to recurrence. Survival endpoints were characterized using the Kaplan-Meier estimator.
The p-values were obtained from the stratified log-rank test with tumor size, histology, and smoking status as stratification factors. Hazard ratios (HRs) and their confidence intervals (CIs) were estimated using stratified Cox proportional hazards models. All reported p-values are two-sided without adjustment for multiplicity. All statistical analyses were conducted by Alliance study statisticians, with the data locked down on June 21, 2022. Statistical analyses were done in SAS, version 9.4 (SAS Institute), and figures were generated in R, version 4.3.3 (R Foundation). Data quality was ensured by review of data by the Alliance Statistics and Data Management Center and by the study chairperson following Alliance policies.
Results
The age distribution of the patients enrolled on CALGB 140503 was as follows: <65 years (n = 254), 65 to 75 years (n = 314), and >75 years (n = 129). Of the 254 patients <65 years old, 131 were assigned to lobar resection and 123 to sublobar resection. The corresponding numbers in the 65-75 age group were 161 and 153, respectively, and 65 and 64, respectively, in the >75 cohort. The median follow-up of these patients was 7 years. Baseline characteristics (Table 1) were matched between the three cohorts, except for smoking status (57.9%, 32.5%, and 27.9% currently using tobacco in the <65, 65-75, and >75 cohorts; p=<.01) and mean percent predicted FEV1 (82.4, 83.9, 87.9, respectively; p=0.03). There were no differences among the three groups in the number of lymph nodes sampled or T-stage, but a higher proportion of patients <65 (5.5%) and >75 (4.7%) had N1 disease, compared with the 65-75 years group (1.0%) (p=0.03).
Table 1:
Baseline Characteristics By Age
| Characteristic | Age Group (Years) | Total | P-value | ||
|---|---|---|---|---|---|
| < 65 (N=254) | 65-75 (N=314) | 75+ (N=129) | N=697 | ||
| Age (Years) | <.00011 | ||||
| Mean (SD) | 57.9 (5.10) | 69.8 (2.80) | 78.9 (3.40) | 67.2 (8.68) | |
| Median | 58.7 | 69.8 | 77.9 | 67.9 | |
| Gender, n (%) | 0.32 | ||||
| Male | 101 (39.8%) | 134 (42.7%) | 62 (48.1%) | 297 (42.6%) | |
| Female | 153 (60.2%) | 180 (57.3%) | 67 (51.9%) | 400 (57.4%) | |
| ECOG Performance Status n (%) | 0.082 | ||||
| 0 | 194 (76.4%) | 234 (74.5%) | 85 (65.9%) | 513 (73.6%) | |
| 1/2 | 60 (23.6%) | 80 (25.5%) | 44 (34.1%) | 184 (26.4%) | |
| Maximum diameter of tumor - lung window settings (cm) | 0.391 | ||||
| N (Missing) | 254 (0) | 314 (0) | 128 (1) | 696 (1) | |
| Mean (SD) | 1.5 (0.35) | 1.5 (0.35) | 1.5 (0.38) | 1.5 (0.36) | |
| Median | 1.5 | 1.5 | 1.5 | 1.5 | |
| Tumor Size (cm), n (%) | 0.242 | ||||
| <1.0 | 29 (11.4%) | 22 (7.0%) | 7 (5.4%) | 58 (8.3%) | |
| 1.0-1.5 | 127 (50.0%) | 160 (51.0%) | 67 (51.9%) | 354 (50.8%) | |
| >1.5-2.0 | 98 (38.6%) | 132 (42.0%) | 55 (42.6%) | 285 (40.9%) | |
| Smoking Status, n (%) | <.00012 | ||||
| Never | 20 (7.9%) | 31 (9.9%) | 12 (9.3%) | 63 (9.0%) | |
| Former | 87 (34.3%) | 181 (57.6%) | 81 (62.8%) | 349 (50.1%) | |
| Current | 147 (57.9%) | 102 (32.5%) | 36 (27.9%) | 285 (40.9%) | |
| Histology, n (%) | 0.052 | ||||
| Squamous Cell Carcinoma | 26 (10.2%) | 48 (15.3%) | 24 (18.6%) | 98 (14.1%) | |
| Adenocarcinoma | 174 (68.5%) | 200 (63.7%) | 70 (54.3%) | 444 (63.7%) | |
| Other | 54 (21.3%) | 66 (21.0%) | 35 (27.1%) | 155 (22.2%) | |
| Tumor location area, n (%) | 0.162 | ||||
| Right upper lobe | 103 (40.6%) | 102 (32.5%) | 43 (33.3%) | 248 (35.6%) | |
| Right middle lobe | 11 (4.3%) | 20 (6.4%) | 4 (3.1%) | 35 (5.0%) | |
| Right lower lobe | 30 (11.8%) | 52 (16.6%) | 16 (12.4%) | 98 (14.1%) | |
| Left upper lobe | 73 (28.7%) | 75 (23.9%) | 42 (32.6%) | 190 (27.3%) | |
| Left lower lobe | 36 (14.2%) | 61 (19.4%) | 22 (17.1%) | 119 (17.1%) | |
| Lingula | 1 (0.4%) | 4 (1.3%) | 2 (1.6%) | 7 (1.0%) | |
| Forced Expiratory Volume 1 (% Predicted FEV1) | 0.031 | ||||
| Mean (SD) | 82.4 (18.54) | 83.9 (19.35) | 87.9 (22.34) | 84.1 (19.71) | |
| Median | 83.0 | 83.0 | 87.0 | 83.0 | |
| Type of Surgery | 0.982 | ||||
| Lobar resection | 131 | 161 | 65 | 357 | |
| Sublobar resection | 123 | 153 | 64 | 340 | |
| Type of mediastinal lymph node dissection, n (%) | 0.152 | ||||
| Complete | 56 (22.0%) | 91 (29.3%) | 35 (27.3%) | 182 (26.3%) | |
| Systematic sampling | 126 (49.6%) | 159 (51.1%) | 64 (50.0%) | 349 (50.4%) | |
| Simple sampling | 69 (27.2%) | 60 (19.3%) | 29 (22.7%) | 158 (22.8%) | |
| None | 3 (1.2%) | 1 (0.3%) | 0 (0.0%) | 4 (0.6%) | |
| Missing | 0 | 3 | 1 | 4 | |
| Number of lymph nodes sampled | 0.151 | ||||
| Mean (SD) | 4.4 (1.42) | 4.6 (1.47) | 4.7 (1.50) | 4.6 (1.46) | |
| Median | 4.0 | 4.0 | 5.0 | 4.0 | |
| Pathological T stage, n (%) | 0.612 | ||||
| Tis | 0 (0.0%) | 2 (0.6%) | 0 (0.0%) | 2 (0.3%) | |
| T1 | 204 (80.3%) | 260 (82.8%) | 102 (80.3%) | 566 (81.4%) | |
| T2 | 45 (17.7%) | 48 (15.3%) | 20 (15.7%) | 113 (16.3%) | |
| T3 | 4 (1.6%) | 3 (1.0%) | 4 (3.1%) | 11 (1.6%) | |
| T4 | 1 (0.4%) | 1 (0.3%) | 1 (0.8%) | 3 (0.4%) | |
| Missing | 0 | 0 | 2 | 2 | |
| Pathological N Stage, n (%) | 0.032 | ||||
| N0 | 236 (92.9%) | 306 (97.5%) | 120 (94.5%) | 662 (95.3%) | |
| N1 | 14 (5.5%) | 3 (1.0%) | 6 (4.7%) | 23 (3.3%) | |
| N2 | 4 (1.6%) | 5 (1.6%) | 1 (0.8%) | 10 (1.4%) | |
| Missing | 0 | 0 | 2 | 2 | |
ECOG: Eastern Cooperative Oncology Group. SD: standard deviation.
Kruskal-Wallis p-value
Chi-Square p-value.
There was no effect of age on the incidence of high-grade (≥3) adverse events. A total of 29 (11.4%) patients <65 years old, 49 (15.6%) patients 65-75 years old, and 24 (18.6%) patients>75 years old had a high-grade adverse event (p=0.14). These findings remained true when the type of resection was considered. In the lobar resection group, 17 (13.0%), 27 (16.8%) and 11 (16.9%) patients had a high-grade AE in each of the age cohorts (p=0.63), while in the sublobar resection group the corresponding numbers were 12 (9.8%), 22 (14.4%) and 13 (20.3%) in the <65, 65-75 and >75 cohorts, respectively (p=0.14). There was no association between low-grade AE and age at registration. The 90-day mortality was as follows: 1 (0.4%) in the <65 cohort, compared to 5 (1.6%) and 4 (3.1%) in the 65-75 and >75 cohorts, respectively (p=0.09).
Within the sublobar resection group, we specifically evaluated the proportion of patients with high grade AEs in the wedge resection and segmentectomy groups. In the wedge resection cohort, there was no difference in patients with high-grade AE by age: [n=8 (11%), n=10 (10.4%), and n=4 (11.4%) in the <65, 65-75, and 75+ cohorts (p = 1.00), respectively. However, among patients who received a segmentectomy, a higher proportion of patients in the 75+ cohort (n=8; 30.8%) had high-grade AE than in the < 65 (n=4; 8.2%) and 65–75 (n=11; 19.6%) cohorts (p= 0.04).
There was no difference in DFS or OS between lobar and sublobar resection in the three age-based cohorts. In the age <65 cohort, the 5-year DFS was 63.7% in the lobar resection group, compared with 64.8% in the sublobar resection group (p=0.84; Figure 1A). In the 65-75 age cohort, the 5-year DFS was 71.8% in the lobar resection group and 66.1% in the sublobar group (p=0.44), (Figure 1B). The corresponding numbers in the >75 age group were 44.8% and 54.6% respectively (p=0.38), Figure 1C) (Table 2).
Figure 1.
Figures 1A-C show Kaplan-Meier curves for disease-free survival for patients who underwent a lobar and sub-lobar resection by age. Fig. 1A (age <65 years); Fig. 1B (age 65-75 years); Fig. 1C (age >75 years). Figures 1D-F show Kaplan-Meier curves for overall survival for patients who underwent a lobar and sub-lobar resection by age. Fig. 1D (age <65 years); Fig. 1E (age 65-75 years); Fig. 1F (age >75 years).
Table 2:
Outcomes for sublobar resection (lobar resection as reference)
| Outcome | <65 years HR (95% CI, p-value) |
65-75 years HR (95% CI, p-value) |
>75 years HR (95% CI, p-value) |
|---|---|---|---|
| DFS | 1.05 (0.69-1.59, 0.837) | 1.16 (0.80-1.69, 0.438) | 0.79 (0.46-1.34, 0.375) |
| OS | 1.09 (0.64-1.87, 0.742) | 1.04 (0.66-1.63, 0.860) | 0.61 (0.34-1.09, 0.094) |
| TTR | 1.10 (0.71-1.72, 0.665) | 1.24 (0.80-1.92, 0.339) | 0.79 (0.38-1.64, 0.528) |
HR – Hazard ratio
CI – Confidence interval
DFS – Disease-free survival
OS – Overall survival
TTR – Time to recurrence
There was no difference in 5-year OS by surgery type across the three age cohorts. The 5-year OS in the lobar resection group in patients <65 was 83.9%, compared with 83.3% in the sublobar resection group (p=0.74; Figure 1D). In the 65–75-year cohort, the 5-year OS was 83.1% in the lobar resection group and 79.9% in the sublobar resection group (p=0.86, Figure 1E). The corresponding values in the >75 group were 57.5% and 75.4% respectively (p=0.09, Figure 1F) (Table 2).
When outcomes were compared between the three age-based cohorts, the 5-yr DFS was 63.7%, 71.8%, and 44.8%, respectively, in the <65, 65-75, and >75 cohorts assigned lobar resection (Figure 2A). Compared with the <65 cohort, patients >75 years old assigned to lobar resection had a lower DFS (p=0.03). The 5-year OS was 83.9%, 83.1%, and 57.5% in the <65, 65-75, and >75 age cohorts, respectively. Compared to the <65 cohort, the >75 cohort had a worse 5-year OS (p < 0.01), while there was no difference compared to the 65–75-year cohort (Figure 2B) (Table 3).
Figure 2.
Figure 2 shows Kaplan-Meier curves for disease-free survival and overall survival by age for patients who underwent lobar resection (2A, 2B respectively) and sublobar resection (2C and 2D, respectively) and time to recurrence by age in the lobar (2E) and lobar resection (2F) groups.
Table 3:
Outcomes based on age (<65 years as reference)
| Outcome | Age (years) | Lobar HR (95% CI, p-value) | Sublobar HR (95% CI, p-value) |
|---|---|---|---|
| DFS | 65-75 | 0.78 (0.52-1.18, 0.240) | 0.99 (0.65-1.50, 0.954) |
| > 75 | 1.67 (1.06-2.62, 0.027)* | 1.50 (0.91-2.49, 0.115) | |
| OS | 65-75 | 1.17 (0.70-1.94, 0.549) | 1.23 (0.74-2.05, 0.430) |
| > 75 | 2.73 (1.61-4.64, < 0.001)** | 1.74 (0.93-3.25, 0.084) | |
| TTR | 65-75 | 0.71 (0.45-1.12, 0.142) | 0.87 (0.55-1.37, 0.552) |
| > 75 | 1.08 (0.62-1.87, 0.793) | 1.01 (0.55-1.88, 0.966) |
p<0.05
p<0.001
HR – Hazard ratio
CI – Confidence interval
DFS – Disease free survival
OS – Overall survival
TTR – Time to recurrence
There was no difference in DFS or OS by age in the group assigned to sublobar resection. The 5-year DFS was 64.8%, 66.1%, and 54.6% in the <65, 65-75, and >75 cohorts, respectively. Compared with the <65 cohort, there was no difference in DFS between the 65-75 and>75 cohorts (Figure 2C). The 5-year OS was 83.3%, 79.9%, and 75.4% in the <65, 65-75, and >75 cohorts. Similarly, there was no difference in the 5-yr OS (Stratified log-rank: p = 0.23) in the 65-75 and >75 cohorts, compared to the <65 cohort (Figure 2D) (Table 3).
Since the patients in the >75 cohort who underwent a lobectomy had a worse 5-year OS; we looked at time to recurrence to determine if the increased mortality was due to cancer recurrence or other competing causes of death. There were no differences in the time to recurrence between the three age groups in either the lobar resection or sublobar resection cohorts (Figures 2E, 2F) (Table 3). We conducted a multivariate analysis to evaluate factors associated with DFS, OS and TTR in patients >75 (Figures 3A, 3B and 3C, respectively). Nearly all covariates evaluated, namely, procedure performed, sex, ECOG score at surgery, baseline FEV1(%), tumor size, smoking status and histology, were not statistically significantly associated with DFS, OS or TTR. The only exception was ECOG score > 0 and TTR. In addition, a competing risks analysis was performed in patients over the age of 75 to study the effect of non-cancer mortality on the observed survival differences (Figure 4). There were 23 deaths from lung cancer, 15 in the lobar resection group compared to 8 in the sub-lobar group. In comparison, there were 36 non-lung cancer deaths, 20 in the lobar resection group compared to 16 in the sub-lobar group. There was no difference between the cumulative incidence of deaths from lung cancer and other causes of death in the two groups.
Figure 3.
Forest plots of various covariates associated with disease-free survival (3A), overall survival (3B) and time to recurrence (3C)
Figure 4.
Causes of death in patients >75 years, based on relationship to their lung cancer diagnosis in the lobar and sublobar resection groups
Discussion
In this analysis, patients >75 years tolerated surgery, as well as younger patients, with similar rates of high-grade adverse events and 90-day mortality. Similar to the overall results of the CALGB 140503 study,14 there were no differences in outcomes between patients who underwent lobar resection and those who underwent sublobar resection in any of the three age categories. While there was no difference in DFS or OS between the two resection types across the three age groups, patients >75 years who underwent a lobar resection had lower DFS and OS than patients <65 years. However, we did not find a difference in time to recurrence among the three age groups, suggesting that the lower overall survival following lobar resection in patients >75 was most likely due to competing causes of death in this population.
Multiple retrospective studies have compared lobectomy with sublobar resection in older patients with stage I NSCLC.15–21 Most of them demonstrated that the overall survival was similar in both groups. However, the SEER database analysis by Shirvani et al. showed that lobectomy was associated with better overall and lung cancer-specific survival than sublobar resection.17 In a randomized study comparing lobectomy with segmentectomy for stage IA NSCLC, Saji and colleagues found that despite higher local recurrence, patients who received segmentectomy had a better overall survival compared to patients who received a lobectomy22. In that trial (JCOG 0802), more non-cancer-related deaths occurred after lobar resection than after segmentectomy. Our results are concordant with the results reported by Saji et al and suggest that a higher mortality after lobar resection in patients >75, may be due to competing causes of death.
Previous analyses have also demonstrated that older patients and younger patients equally tolerate lung resection, and that age alone should not be a contraindication to offering surgical resection. In a single institution study, Cerfolio et al. found no significant differences in postoperative mortality or morbidity and length of stay between older and younger patients who received pulmonary resection .23 Previous studies in older patients have shown that sublobar resections may be associated with fewer perioperative complications than lobar resections. In a study of 205 patients ≥75 years old with stage I NSCLC, Tsutani and colleagues observed that while overall survival was not significantly different between the lobectomy and the sublobar resection cohorts, severe postoperative complications occurred more frequently in the group that received a lobectomy.21 An extensive retrospective single institution analysis of 2186 patients who received surgical resection for stage I NSCLC found that the noncancer-specific cumulative incidence of death was higher than lung cancer–specific cumulative incidence of death, especially in patients 75 years of age or older24. These findings are similar to ours: worse disease-free and overall survival in older patients, with no difference in time to recurrence.
In a single institution retrospective study of patients ≥75 years old, Kilic et al. observed no difference in the 30-day mortality and median hospitalization between the patients receiving a segmentectomy or lobectomy.15 However, the incidence of major morbidity was higher in the cohort that received a lobectomy (25.5% vs. 11.5%, p=0.02). In contrast, in the present analysis, there were no differences in low-grade or high-grade adverse events based on age, except in the >75 age group that received a segmentectomy. The proportion of high-grade adverse events was 30.8% in this group compared to 8.2% in the <65 age group and 19.6% in the 65-75 years group. Similarly, age did not affect 90-day mortality.
The current consensus in guidelines is that age alone should not be a criterion to determine surgical candidacy in patients with early-stage NSCLC and that older patients who are potential candidates for surgical resection should be offered surgery.25 However, real-world treatment patterns seem to be different, suggesting a possible bias against offering surgery to older patients. A possible reason for this may be that older patients are more likely to have more comorbidities and poor performance status, and therefore less likely to be offered surgery. A recent study evaluating treatment patterns from patients enrolled in the SEER database demonstrated that a much larger proportion of younger patients (<65 years) received surgery for stage I non-small cell lung cancer (78%) compared to patients ≥65 years of age (57.5%).3 That analysis also found that the 5-year survival rate for younger patients with stage I NSCLC was 74.9% compared to 65.3% for older patients. A Japanese study showed similar findings: the proportion of patients undergoing surgery for stage I NSCLC decreased with increasing age.26 In this analysis, 73% of patients aged 65-74 were offered surgery, compared with 35% of patients aged 85+. The results of the present analysis should provide further confidence that fit older patients who have stage I NSCLC can be safely treated with surgery, especially with a sublobar resection. There is emerging evidence that the use of frailty and geriatric assessment scores may predict surgical complications and help in choosing appropriate candidates for lung cancer surgery27.
The limitations of the current analysis are that it is an unplanned subgroup analysis of a large prospective clinical trial, and some subgroups may have been underpowered to obtain definite conclusions. Age was not a factor of stratification in the original trial, and this may have resulted in imbalances in baseline characteristics, such as smoking status and FEV1. Also, this was a highly select group of patients, who had a small peripheral tumor. Thirdly, older patients enrolled in this trial had to be fit enough to be considered, and, based on the biases discussed above, were likely to constitute a very selective cohort. As a result, these findings may not apply to all patients with stage I NSCLC. However, with the increasing use of lung cancer screening and the resultant detection of increased early-stage cancers in older patients28, these results may help inform management of older patients with small peripheral early-stage NSCLC.
In conclusion, sublobar resection resulted in similar outcomes to lobar resection in older patients with peripherally located clinical T1a N0 M0 non-small cell lung cancer. The decreased overall survival among patients >75 years undergoing lobectomy, despite similar recurrence rates, suggests that non-cancer mortality may contribute to the survival difference and might support consideration of sublobar resection in carefully selected elderly patients.
ClinicalTrials.gov number: NCT00499330.
Support:
Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Numbers U10CA180821 and U10CA180882 (to the Alliance for Clinical Trials in Oncology), UG1CA233253. Also supported in part by funds from Covidien/Tyco/Ethicon. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. https://acknowledgments.alliancefound.org
Footnotes
Disclosures:
AKG: AstraZeneca, Cardinal Health, Jazz Pharmaceuticals, Catalyst Pharmaceuticals, Amgen, Boehringer Ingelheim, Fosun Pharma, Merck, Sanofi Genzyme, Mirati Therapeutics, EMD Serono
BD: Nothing to disclose
XW: Nothing to disclose
TES: Takeda, Gilead Sciences, Coherus Biosciences, Boehringer Ingelheim, Pfizer, AbbVie, Janssen Oncology
NA: Regeneron Pharmaceuticals
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