Defining the High-Risk Population for Mortality After Resection of Early Stage NSCLC

The National Cancer Data Base was examined for predictors of 30-day mortality (30-DM) in early stage none small-cell lung cancer patients undergoing resection. The rate of 30-DM was 2.2%. Age, community treatment center, male sex, and Charlson-Deyo comorbidity score were predictive of higher mortality. Extent of resection was predictive of higher 30-DM in patients aged ‡ 75 years.

Background: Studies examining morbidity after lobectomy for early stage non-small-cell lung cancer (NSCLC) demonstrate a > 50% incidence of complications in patients aged ≥ 65 years. Factors that affect 30-day mortality (30-DM), however, are less well defined.

Materials and methods: The National Cancer Data Base was used to identify patients age ≥ 19 years with stage I NSCLC between 2003 and 2011. Data from patients undergoing lobectomy or sublobar resection was abstracted. Univariable and multivariable logistic regression analyses were performed for predictors of 30-DM.

Results: A total of 71,175 patients met inclusion criteria. Of these, 81% underwent lobectomy and 19% underwent sublobar resection. The median age was 68 years. Charlson-Deyo (CD) comorbidity score was 0 in 49% of patients and 1 or higher in 51%. The rate of 30-DM was 2.2%. On multivariable analysis, younger age, CD score of 0, female sex, tumor size ≤ 3 cm, and treatment at an academic center was associated with lower 30-DM (P < .001). A model of 30-DM incorporating age, comorbidity, and extent of surgery was created. In patients aged < 75 years without comorbidities, 30-DM was 1.3%. However, in elderly patients (≥ 75 years old) with CD score of 2, this rate quadrupled to 5.8% (P < .01). Lobectomy patients in this group had higher 30-DM compared to sublobar resection patients (6.6% vs. 3.9% respectively, P < .01).

Conclusion: The 30-DM rate following sublobar or lobar resection in this national sample was low. Extent of resection appears to influence 30-DM in the elderly. Elderly patients with a CD score of 2 undergoing lobectomy represent a high-risk group for 30-DM.