Journal of Surgical Oncology 3 4 19-21 (1987)

Lung Cancer in Men Aged 75 or Older

DEBA P. SARMA, MD

From the Department of Pathology, Veterans Administration Medical Center and Louisiana State University Medical Center, New Orleans

Sixty-seven cases of lung cancer occurring in men aged 75 or older were examined at autopsy. There is a similar incidence of epidermoid and small cell carcinoma, but a lower incidence of adenocarcinoma and a slightly higher incidence of large cell carcinoma in this elderly group of patients compared to the incidence of various histologic types occurring in patients of all ages. The various organs involved by metastatic tumor are similar to those seen in lung cancer in general; the overall metastatic disease is less widespread in the older group.

KEY Wows: geriatric lung neoplasm, cancer in elderly

INTRODUCTION In the United States lung cancer is the leading cause of

cancer death among men. In 1981 lung cancer killed 76,764 men, of which 17,143 (22%) were 75 years of age or older [ 11.

This study was undertaken to review the histologic types and metastatic patterns of lung cancer occurring in men aged 75 or older and to compare the findings to those reported in lung cancers occurring in all ages.

MATERIALS, METHODS, AND RESULTS The records of all patients autopsied over a 20-year

period (January 1, 1960 - December 31, 1979) at the New Orleans Veterans Administration Medical Center were reviewed. A total of 5,594 autopsies were done, which included 786 patients who died of lung cancer. Among these patients, 67 men were 75 years of age or older. Histologic types of lung cancer of this group are shown in Table I. The oldest patient was 89 years of age; the majority of the patients (54 out of 67) were 75 to 80 years old. Only 6 patients were 85 years of age or older. Metastases to various sites as noted at the autopsy are listed in Table 11.

DISCUSSION The 67 cases of lung cancer among men 75 years of

age or older constituted 8.5% of all lung cancer patients autopsied during the 20-year period. This observation is somewhat lower than that reported in an autopsy study [2] where the authors noted 73 cases of lung carcinomas occurring in patients aged 70 or above among a total of

658 cases of autopsied lung carcinomas. This constituted an incidence of 11 % . In another larger autopsy series [3], a total of 815 lung cancers were recorded in patients aged above 70 among a total of 7,000 cases of lung cancer, constituting an incidence of 11.6%. The lower incidence in my study is probably due to the fact that I collected data on the patients aged 75 and above, whereas the referred [2,3] autopsy studies included patients aged 70 and above. Autopsy incidence of lung cancer in el- derly patients is much higher than lung cancer incidence at ages 75-99 noted by the Third National Cancer Survey (1969-197 1) [4]. There were 1,803 cases of cancer of the respiratory tract per 100,000 whites in the United States, an incidence rate of 1.8%.

Of the various histologic types of lung cancer, epider- moid carcinomas account for about 30% and small cell carcinomas about 20 to 25 % of bronchogenic carcinomas [5] in the general population. In the present study, epi- dermoid carcinomas and adenocarcinomas constituted a similar (30% and 24%) proportion of lung cancers (Table I). Whereas 30 to 35% of bronchogenic carcinomas are adenocarcinomas in the overall population [6], I found a slightly lower (22%) incidence in the elderly men. Large cell carcinomas constitute about 10 to 15% of broncho- genic carcinomas [5]. Occurrence of large cell carcinoma was slightly higher (22%) among the elderly patients in the present study.

Accepted for publication April 6, 1985. Address reprint requests to Deba P. Sarrna, MD, V.A. Medical Center, 1601 Perdido Street, New Orleans, LA 70146.

0 1987 Alan R. Liss, Inc.

20 Sarma

Observation of other authors [7,8] regarding incidence of various cell types of lung cancer occurring in patients of all ages studied at autopsy are comparable to that observed in this study (Table I). Auerbach et a1 [7], in a study of 662 autopsied cases of lung cancer, noted epi- dermoid carcinoma in 35 % , small cell carcinoma in 25 % , adenocarcinoma in 25%, and large cell carcinomas in 14% of cases. Matthews et al [8] studied 418 lung cancer patients at autopsy and noted 38% epidermoid carcino- mas, 24% small cell carcinomas, 26% adenocarcinomas, and 19 % large cell carcinomas.

Auerbach et a1 [7], in an autopsy study of 139 cases of lung cancer occurring in men aged 70 or above, noted 46.8% epidermoid carcinomas, 18.7% small cell carci- nomas, 20.1 % adenocarcinomas, and 13.7% large cell carcinomas. In the elderly men aged 75 or above, I noted a lower number of epidermoid carcinomas (30%) and a slightly higher occurrence of large cell carcinomas (22 %) when compared to the former observations. World Health Organization histological typing of lung tumors [9] was used to classify the cancers in the present study. Auer- bach et al [7] also used the WHO classification [lo] for their study. I cannot explain the large difference between the incidence of epidermoid carcinoma in the elderly men

TABLE I. Histologic Types of 67 Lung Cancers in Elderly Men

Cell tvw No. of cases Percentage

Epidermoid carcinoma 20 30 Small cell carcinoma 16 24 Adenocarcinoma 15 22 Large cell carcinoma 15 22 Others: Mixed adeno-squamous 1 2

Carcinoma

observed by Auerbach et a1 [7] and that observed in the present study.

Metastasis was noted at autopsy in 85% of the cases in this study. This incidence is lower than the incidence of metastasis of 96.3 % at autopsy of lung cancer patients of all ages noted by Auerbach et al [7]. Lymph node metas- tases were also lower (74%) in this study compared to Auerbach’s observation (89.1 %). The most common sites of blood-borne metastases in this study included bone (39%), liver (35%), adrenal glands (35%), other lung (33%), and brain (28%). Various organs involved by metastatic tumors as well as the metastatic patterns of the individual cell types of lung cancer in this study are similar to those observed for lung cancer in general [7]. However, the elderly men seem to have fewer metastases for all lung cancer as well as for individual cell types of lung cancer. This finding is in agreement with the obser- vation of other authors [3,11]. One explanation for the reduced frequency and extent of metastatic disease in older cancer patients is that the patients die before the development of extensive spread. It has been suggested [Ill that senescent host factors in older people impede aggressive tumor growth and spread, and it is also argued [3] that the lower metastatic pattern in older patients is probably due to obliterative changes in the lymphatic system. This idea probably explains in part the lower frequency of observed lymphatic metastasis, but not blood-borne metastasis.

The data from the present study show that the epider- moid carcinoma and small cell carcinoma occur at the same rate among the patients below or above 75. Ade- nocarcinoma shows a lower incidence and the large cell carcinoma shows a slightly higher incidence among older

TABLE 11. Metastases of Lung Cancer in Elderly Men

Carcinoma Total Epidermoid Small cell Adeno Large cell Mixed

Number of patients 67 20 16 15 15 1 Any metastasis 57 17 16 14 9 I Lymph nodes 42 12 12 10 8 0

Adrenal glands 20 4 5 6 4 1 Other lung 19 7 4 4 4 0 Brain 16 4 6 3 3 0 Kidneys 12 3 4 I 4 0 Chest wall, skeletal 5 3 1 0 1 0

Pancreas 5 0 3 2 0 0 Stomach, intestines 3 1 1 1 0 0 Diaphragm 3 1 2 0 0 0 Thyroid 3 1 1 1 0 0 Spleen 3 0 1 1 1 0 Skin 2 2 0 0 0 0 Heart, pericardium 2 2 0 0 0 0 Prostate 1 0 1 0 0 0

Bone 22 6 6 6 4 0 Liver 20 4 7 6 2 1

muscle

Lung Cancer in Elderly Men 21

men. Although the various organs involved by metastatic tumor are similar to those seen in lung cancer in general, the overall metastatic disease is less in the older group.

ACKNOWLEDGMENT The author thanks Mrs. Roey Holliday for excellent

secretarial assistance.

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