A Retrospective Cohort Study of neoadjuvant chemotherapy in elderly oncology patients with non-small cell lung cancer
DOI:
https://doi.org/10.5281/zenodo.22813236Keywords:
Non-small cell lung cancer, Neoadjuvant chemotherapy, Elderly, Retrospective cohort, Surgical resectionAbstract
Background: Neoadjuvant chemotherapy before surgical resection improves survival in patients with resectable non-small cell lung cancer (NSCLC), but evidence supporting its use specifically in elderly patients remains limited, since landmark trials enrolled populations substantially younger, on average, than those treated in routine geriatric oncology practice.
Methods: We conducted a retrospective cohort study of patients aged 70 years or older with clinical stage IB-IIIA NSCLC who underwent curative-intent resection at three tertiary centers in Taiwan, Singapore, and Japan between 2014 and 2022. Outcomes for 164 patients who received neoadjuvant chemotherapy followed by surgery were compared with 151 patients who underwent upfront resection, using chi-square, Mann-Whitney U, Kaplan-Meier, and multivariable Cox regression analyses.
Results: R0 resection was achieved in 91% of the neoadjuvant cohort versus 86% of the upfront-surgery cohort, and 90-day morbidity of Clavien-Dindo grade II or higher was 27% versus 24%. Three-year overall survival was 58% versus 47% (log-rank p=0.03), and three-year disease-free survival was 49% versus 38%. Neoadjuvant chemotherapy remained independently associated with improved overall survival after multivariable adjustment (hazard ratio 0.71, 95% confidence interval 0.53-0.95).
Conclusion: Neoadjuvant chemotherapy followed by surgery was associated with improved survival relative to upfront resection among elderly patients with resectable NSCLC, without a clinically meaningful increase in perioperative morbidity or mortality, supporting its use in carefully selected older patients on the basis of functional status rather than chronological age alone.
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