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Validation of a Model to Predict Perioperative Mortality from Lung Cancer Resection in the Elderly

¹ Mount Sinai School of Medicine, New York, New York; ² Division of General Internal Medicine, Mount Sinai School of Medicine, New York, New York; ³ Division of Thoracic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and ⁴ Division of Pulmonary, Critical Care, and Sleep Medicine, Mount Sinai School of Medicine, New York, New York

Correspondence and requests for reprints should be addressed to Juan P. Wisnivesky, M.D., M.P.H., Department of Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place, Box 1087, New York, NY 10029. E-mail: juan.wisnivesky{at}mssm.edu

Rationale: Surgical resection is the mainstay therapy for localized non–small cell lung cancer (NSCLC), yet elderly patients are less likely to be treated due to concerns about morbidity and mortality related to surgery.

Objectives: To validate and refine a clinical model to predict 30-day perioperative mortality (POM) in elderly patients undergoing curative resection for lung cancer.

Methods: We identified 14,297 patients aged 65 years and older with stage I, II, or IIIA NCSLC from the Surveillance, Epidemiology, and End-Results Registry linked to Medicare claims. We used logistic regression analysis to identify independent risk factors for POM and to validate and refine a previously derived prediction model.

Measurements and Main Results: Overall, POM was 4.6% (95% confidence interval, 4.2–4.9%). Multiple regression analysis revealed that greater age, male sex, resections of multiple lobes, advanced stage, greater tumor size, and certain comorbidities were associated with increased risk for POM. These risk factors were similar to those observed in the prior model. When patients were stratified according to their predicted risk of POM, the observed mortality increased from 1.2 to more than 10%.

Conclusions: Among elderly patients with lung cancer, a prediction rule can identify those patients at higher risk for fatal complications from surgery. Further studies should evaluate whether use of the model can lead to improvements in treatment decision making.

Key Words: lung malignancy • lung resection • risk assessment • surgical outcomes

AT A GLANCE COMMENTARY Scientific Knowledge on This Subject For elderly patients with lung cancer, the risk of perioperative mortality from resection is an important concern. A clinical rule can help physicians and patients make informed treatment decisions and anticipate potential complications from surgery. What This Study Adds to the Field Using a population-based cancer registry, we validated and refined a model to predict perioperative mortality in an elderly population undergoing lung cancer resection.

 

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				J.-J. Hung, J.-S. Liu, and W.-J. Jeng Prediction of Perioperative Mortality after Lung Cancer Resection in the Elderly Am. J. Respir. Crit. Care Med., October 15, 2009; 180(8): 794 - 794. [Full Text] [PDF]

				M. Kates and J. P. Wisnivesky Prediction of Perioperative Mortality after Lung Cancer Resection in the Elderly Am. J. Respir. Crit. Care Med., October 15, 2009; 180(8): 794 - 795. [Full Text] [PDF]