Recent Trends in Use of Adjuvant Chemotherapy in Elderly Stage II– III Non-Small Cell Lung Cancer

Takefumi Komiya; Emily Powell; Achuta Kumar Guddati

Disclosures

Transl Lung Cancer Res. 2020;9(4):1180-1186. 

In This Article

Results

A total of 35,009 cases were selected for the analysis. Clinical characteristics are shown in Table 1. In total, 19,951 (57.0%) patients received chemotherapy. Its use was more frequent in female, non-white race, age 20–69, year of diagnosis between 2010 and 2015, adenocarcinoma histology, and stage III groups per univariate analysis.

Multivariate analysis demonstrated that younger age, recent year of diagnosis, adenocarcinoma histology, and stage III showed significantly higher rates of chemotherapy use (Table 2). Of note, young age [20–69] and recent diagnosis [year 2010–2015] had 2.67- and 1.27-fold higher incidence of chemotherapy use, respectively, per multivariate analyses. Subgroup analysis in age 70+ also demonstrated that the same variables including younger age [70–79] were associated with higher incidence of chemotherapy (Table S1 and Table S2).

Use of chemotherapy in the overall population increased by 12.9%, from 49.5% in 2004 to 62.4% in 2015 (Table 3). This increase was more prominent in age 70–79 (18.3%, from 39.9% to 58.2%) than in age 20–69 (11.0%, from 59.1% to 70.2%) and age 80+ (11.3%, from 18.3% to 29.6%) (Figure 1).

Figure 1.

Trends in use of perioperative chemotherapy in stage II– III by age. The median % of population receiving chemotherapy was plotted. Total, all age groups.

Increase in use of chemotherapy in the age 70–79 group was greater than in other age groups regardless of stage or histology (Table 3, Figures 2,3). It was more prominent in stage II (24.3% increase, from 33.6% to 57.9%). In patients age 80 and older, use of chemotherapy remains low (approximately 30%) and mildly increased over the decades.

Figure 2.

Trends in use of perioperative chemotherapy by stage and age. The median % of population receiving chemotherapy was plotted. (A) Stage II; (B) stage III. Total, all age groups.

Figure 3.

Trends in use of perioperative chemotherapy by histology and age. The median % of population receiving chemotherapy was plotted. (A) Adenocarcinoma; (B) non-adenocarcinoma. Total, all age groups.

To determine if increased use of chemotherapy resulted in improved survival, we conducted a survival analysis by determining 5-year survival rate (Figure 4). Our analysis was limited by available data up to year 2011. Analysis of all age groups showed that 5-year overall survival only mildly increased by 5.6%, from 37.3% in 2004 to 42.9% in 2011. In age 20–69, 70–79, 80+ groups, 5-year overall survival increased by 5.9%, 7.6%, and 1.0% respectively.

Figure 4.

Trends in 5-year overall survival in stage II–III cases by age. The five-year survival rate (%) was plotted according to year of diagnosis. Total, all age groups.

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