The comparison of the effects of comorbidity factors on survival in stage IIIB and stage IV non-small cell lung cancer patients aged 65 years and over or under 65 years

OBJECTIVEThe aim of the study is the comparision of the effects of comorbidity factors on survival in stage IIIB and stage IV non-small cell lung cancer (NSCLL) patients aged 65 years and older or under 65 years.MATERIAL AND METHODA total of 221 patients who were diagnosed histopathologically NSCLL as stage III B and and stage IV and received therapy and followed between May 1998 to April 2009 in Medical Oncology Department of Dokuz Eylul University School of Medicine. Patients were grouped as 65 years and older and under 65 years. The comorbidity situation of patients were evaluated by Charlson Comorbidity Index. The points of patients were evaluated between 0 ( No commorbidity) to 10 (maximum comorbidity). The patients were also grouped for analysis as 0, 1-2, 3-4 and 5 or more by Charlson scores. The statistical evaluations of the results were made by SPSS 11.0 for Windows. Kaplan-Meier method was used to produce survival curves.RESULTSEightysix (% 39) of 221 patients were 65 years and older and 135 (% 61) of 221 patients were under 65 years. In the group of patients of 65 years and older, comorbidities as chronic lung disease (% 38.4), coronary artery disease (% 24.4) and diabetes (%23.3) were seen more frequently and for 65 years under, chronic lung disease (% 26.7), diabetes (% 17.8) and chronic renal disease (%9.6) were the most frequently seen complications. In the group of 65 years and older, there were 12 patients in Charlson-0 (%.14), 51 patients in Charlson-1 (%59.3), 10 patients in Charlson-2 (%11.6), 13 patients in Charlson-3 (%15.1) and in the group of under 65 years, there were 50 patients in Charlson-0 (%37.3), 62 patients in Charlson-1 (%45.9), 17 patients in Charlson-2 (%12.6) and 6 patients in Charlson-3 (%4.4).In 65 years and older group, 78 of 86 patients (% 90.8) and in under 65 years group 121 of 135 patients were recieved systemic chemotherapy; in both groups, we observed that, combination of gemcitabine plus platinum was the most chosen regimen. Evaluation of toxicities revealed that grade 3-4 hematologic and non-hematologic toxicities were seen respectively as % 33.3 and % 33.3 in the group of 65 years and older; under 65 years they were seen as % 20.5 and % 33.3 respectively.In all patients, median progression free survival was 9.1 month, median survival was 17 months and 1,2 and 3 year survival rates were % 61.3, % 31.7 and % 20.2 respectively. In patients aged 65 years and older, median progression free survival was 9,7 month, median survival was 15 month and 1,2 and 3 year survival rates these paremeters were (% 57.2), (% 22.2), (% 12,7) respectively and in group under 65 years, 8,57 month, 18 month (% 62.9), (% 37.8), (% 25.3) respectively. Survival parameters that were evaluated for Charlson index revealed that, in group 65 years and older, median survival in Charlson group 0, 1, 2 and 3 were 44 months, 16 months, 10 months and 10 months respectively and in group under 65 years, median survival in Charlson group 0, 1, 2 and 3 were 19 months, 18 months, 11 months and 11 months respectively. There were not any significance for the effect of comorbidity factors on survival between two groups.CONCLUSIONIn stage IIIB and stage IV NSCLL patients, as age increases, comorbidity factors and (in paralel) therapy-related toxicity increases; median survival of the patients are affected negatively and there were not any difference for overall survival related to age. Because the patients with high charlson comorbidity score have shorter survival, we have to evaluate these patients carefully.