LUNG cancer surgery showed durable survival and quality-of-life outcomes in carefully selected octogenarians with early-stage NSCLC.
Lung Cancer Surgery Outcomes After 80
Curative-intent lung cancer surgery may be feasible for carefully selected adults aged 80 years and older with stage IA non-small cell lung cancer, according to prospective cohort data comparing octogenarians with younger patients.
The analysis included 884 patients with first primary stage IA NSCLC measuring 30 mm or less who underwent surgical resection between 2016 and December 2024. Of these, 114 patients were octogenarians and 770 were younger than 80 years. Median age was 82 years in the octogenarian group and 69 years in the younger cohort.
Baseline comorbidities were broadly similar between groups, although chronic obstructive pulmonary disease was less frequent among octogenarians. Tumor and nodule features were also comparable overall, but octogenarians had slightly larger resected tumors, more adenocarcinoma, and more frequent angiolymphatic invasion.
Complications Increased, But Recovery Was Similar
Surgical approach differed by age. Octogenarians underwent fewer lobectomies and more sublobar resections, including wedge resections and segmentectomies. Postoperative hospital stay was similar, with a median of 3 days, but complications were more common among octogenarians than younger patients.
Complication rates were 40% in octogenarians compared with 22% in younger patients. Urologic complications, largely related to urinary catheter use, were especially frequent, and neurologic events were also higher in the older cohort. Cardiovascular events were numerically more common. However, intensive care unit admissions, 30-day readmissions, pulmonary complications, and infectious complications did not differ significantly. No deaths occurred within 30 days of surgery.
Quality of Life Recovered by 12 Months
Quality-of-life data were available for 835 patients. Physical health scores declined in both groups at 2 months after surgery, then recovered by 12 months. Mental health scores also remained comparable between groups over time.
Differences in physical and mental component scores between octogenarians and younger patients were small and not clinically significant. The findings suggest that, in selected older adults, lung cancer surgery may not impose a sustained quality-of-life penalty compared with outcomes seen in younger patients.
At a median follow-up of 4.28 years, 5-year overall survival was 84.2% in octogenarians and 87.3% in younger patients. Five-year lung cancer–specific survival was nearly identical, at 94.4% and 94.5%, respectively. Adjusted analyses showed no statistically significant difference in overall mortality or lung cancer–specific mortality by age group.
These data challenge the use of chronological age alone in lung cancer surgery decisions and support individualized assessment based on functional status, comorbidities, tumor features, and patient preference.
Reference
Gros L et al. Surgical outcomes and quality of life in octogenarians with early-stage non-small cell lung cancer: a prospective cohort study. The Lancet Regional Health – Americas. 2026;56:101428.
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