Metastasis Patterns and Prognosis of Octogenarians with NSCLC: A Population-based Study
Yu Gu1,2, Junhua Zhang1,2, Zhirui Zhou1,2, Di Liu1,2, Hongcheng Zhu1,2, Junmiao Wen1,2, Xinyan Xu1,2, Tianxiang Chen3,*, Min Fan1,2,*
1Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China. 2Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China. 3Shanghai Lung Cancer Center, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China.
Non-small cell lung cancer (NSCLC) is the most common cancer and the leading cause of cancer-related deaths worldwide. Age at diagnosis of advanced NSCLC is much older, but studies describing the practice patterns for octogenarians with distant metastasis NSCLC are limited. A retrospective, population-based study using national representative data from the Surveillance, Epidemiology, and End Results (SEER) program was conducted to evaluate 34 882 NSCLC patients with extrathoracic metastases from 2010 to 2013. Patients were classified into three groups (older group: ≥80 yrs, middle-aged group: 60-79 yrs, and younger group: ≤59 yrs). The role of different age at diagnosis of NSCLC in metastasis patterns was investigated, and survival of different age groups of metastatic NSCLC was assessed. The analysis revealed that older patients were more likely to only have bone or liver metastasis (p< 0.001), but less likely to have brain only metastasis (p<0.001) and multiple metastatic sites (p< 0.001) than other two groups. Age at diagnosis was an independent risk factor for different metastasis types. Older group had the worst overall survival (p<0.001) and cancer-specific survival (p<0.001). Furthermore, older age patients with only bone metastasis had the best cancer specific survival (p<0.05) while younger patients with only brain metastasis had the best prognosis (p<0.001). Over 60% octogenarians with metastatic NSCLC did not receive anti-cancer therapy and had the highest rate of cancer deaths among all patients. Our results may help clinicians make positive decisions regarding personalized treatment of metastatic NSCLC in the elderly.
Yu Gu,Junhua Zhang,Zhirui Zhou, et al. Metastasis Patterns and Prognosis of Octogenarians with NSCLC: A Population-based Study[J]. Aging and disease,
2020, 11(1): 82-92.
Figure 1. Distant metastatic patterns of different age groups. Metastasis patterns of adenocarcinoma (A) and non-adenocarcinoma (B) were analyzed. Different patterns of multiple metastatic sites of adenocarcinoma (C) and non- adenocarcinoma (D) were also analyzed.
Figure 2. Multivariable logistic regression analyses predicting different sites of metastasis in adenocarcinoma patients. (A) only bone metastasis; (B) only brain metastasis; (C) only liver metastasis; (D) multiple metastatic sites. Abbreviation: NOS= not otherwise specified.
Figure 3. Multivariable logistic regression analyses predicting different sites of metastasis in nonadenocarcinoma patients. (A) Only bone metastasis; (B) only brain metastasis; (C) only liver metastasis; (D) multiple metastatic sites. Abbreviation: NOS= not otherwise specified.
Figure 4. Kaplan-Meier curve of OS (A) and CSS(B) by age groups among NSCLC patients with extrathoracic metastases. Abbreviation: OS=overall survival, CSS=cancer-specific survival
AD
NAD
<=59 yrs
60-79 yrs
>=80 yrs
Total
P value
<=59 yrs
60-79 yrs
80yrs
Total
p-value
(n=6757, 31.1%)
(n=12500, 57.5%)
(n=2465, 11.3%)
(n = 21722)
(n =1195, 14.2%)
(n = 5296, 62.9%)
(n =1929, 22.9%)
(n = 8420)
Race
Black
1168(17.3%)
1471(11.8%)
154(6.2%)
2793(12.9%)
<0.001
296(15.3%)
734(13.9%)
98(08.2%)
1128(13.4%)
<0.001
White
4821(71.3%)
9771(78.2%)
2039(82.7%)
16631(76.6%)
1508(78.2%)
4243(80.1%)
1014(84.9%)
6765(80.3%)
Other#
746(11.0%)
1227(9.8%)
268(10.9%)
2241(10.3%)
120(6.2%)
316(6.0%)
80(6.7%)
516(6.1%)
Unknown
22(0.3%)
31(0.2%)
4(0.2%)
57(0.3%)
5(0.3%)
3(0.1%)
3(0.3%)
11(0.1%)
Gender
Male
3584(53.0%)
6750(54.0%)
1165(47.3%)
11499(52.9%)
<0.001
1292(67.0%)
3401(64.2%)
711(59.5%)
5404(64.2%)
<0.001
Female
3173(47.0%)
5750(46.0%)
1300(52.7%)
10223(47.1%)
637(33.0%)
1895(35.8%)
484(40.5%)
3016(35.8%)
Histologic grade
Well
120(1.8%)
267(2.1%)
73(3.0%)
460(2.1%)
<0.001
23(1.2%)
71(1.3%)
19(1.6%)
113(1.3%)
0.003
Moderately
749(11.1%)
1430(11.4%)
266(10.8%)
2445(11.3%)
221(11.5%)
729(13.8%)
180(15.1%)
1130(13.4%)
Poorly
1673(24.8%)
3065(24.5%)
518(21.0%)
5256(24.2%)
594(30.8%)
1700(32.1%)
349(29.2%)
2643(31.4%)
Undifferentiated
47(0.7%)
59(0.5%)
11(0.4%)
117(0.5%)
61(3.2%)
150(2.8%)
19(1.6%)
230(2.7%)
Unknown
4168(61.7%)
7679(61.4%)
1597(64.8%)
13444(61.9%)
1030(53.4%)
2646(50.0%)
628(52.6%)
4304(51.1%)
T stage
T0
69(1.0%)
129(1.0%)
21(0.9%)
219(1.0%)
0.014
23(1.2%)
37(0.7%)
7(0.6%)
67(0.8%)
0.09
T1
779(11.5%)
1476(11.8%)
263(10.7%)
2518(11.6%)
138(7.2%)
357(6.7%)
73(6.1%)
568(6.7%)
T2
1518(22.5%)
3006(24.0%)
598(24.3%)
5122(23.6%)
459(23.8%)
1331(25.1%)
298(24.9%)
2088(24.8%)
T3
1524(22.6%)
2648(21.2%)
523(21.2%)
4695(21.6%)
464(24.1%)
1351(25.5%)
312(26.1%)
2127(25.3%)
T4
1959(29.0%)
3492(27.9%)
670(27.2%)
6121(28.2%)
620(32.1%)
1620(30.6%)
342(28.6%)
2582(30.7%)
Tx
908(13.4%)
1749(14.0%)
390(15.8%)
3047(14.0%)
225(11.7%)
600(11.3%)
163(13.6%)
988(11.7%)
N stage
N0
1229(18.2%)
2612(20.9%)
654(26.5%)
4495(20.7%)
<0.001
305(15.8%)
1090(20.6%)
337(28.2%)
1732(20.6%)
<0.001
N1
474(7.0%)
1004(8.0%)
169(6.9%)
1647(7.6%)
136(7.1%)
464(8.8%)
103(8.6%)
703(8.3%)
N2
2976(44.0%)
5488(43.9%)
1026(41.6%)
9490(43.7%)
894(46.3%)
2456(46.4%)
503(42.1%)
3853(45.8%)
N3
1712(25.3%)
2538(20.3%)
372(15.1%)
4622(21.3%)
495(25.7%)
967(18.3%)
157(13.1%)
1619(19.2%)
Nx
366(5.4%)
858(6.9%)
244(9.9%)
1468(6.8%)
99(5.1%)
319(6.0%)
95(7.9%)
513(6.1%)
Treatment
Radiotherapy
3933(58.2%)
6118(48.9%)
926(37.6%)
10977(50.5%)
<0.001
1109(57.5%)
2497(47.1%)
433(36.2%)
4039(48.0%)
<0.001
Surgery and diotherapy
151(2.2%)
144(1.2%)
6(0.2%)
301(1.4%)
45(2.3%)
83(1.6%)
6(0.5%)
134(1.6%)
No therapy
2477(36.7%)
5916(47.3%)
1483(60.2%)
9876(45.5%)
699(36.2%)
2559(48.3%)
724(60.6%)
3982(47.3%)
Surgery
91(1.3%)
152(1.2%)
17(0.7%)
260(1.2%)
36(1.9%)
65(1.2%)
12(1.0%)
113(1.3%)
Unknown
105(1.6%)
170(1.4%)
33(1.3%)
308(1.4%)
40(2.1%)
92(1.7%)
20(1.7%)
152(1.8%)
Table 1 Characteristics of patients with extrathoracic metastatic AD and NAD by age groups.
Figure 5. Kaplan-Meier curve of OS and CSS according to metastasis sites in all (A-B), older (>79 yrs) (C-D), middle-aged (60-79 yrs) (E-F), and younger (<60 yrs) (G-H) patients with NSCLC. Abbreviation: OS=overall survival, CSS=cancer-specific survival.
Figure 6. Rates of cancer death for different metastasis sites by age group.
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2020,
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