Presentation (CTI)

OBJECTIVES: To assess the clinical effectiveness and safety of platinum-based adjuvant chemotherapy in elderly patients (aged ≥65 years) with non-small cell lung cancer (NSCLC) who underwent curative surgical resection.
METHODS: A systematic review and meta-analysis was conducted following PRISMA guidelines. Ovid-MEDLINE, Ovid-EMBASE, Cochrane CENTRAL, KoreaMed, KMbase, and KISS were searched (August-September 2024) for English and Korean articles published through 2024. Eligible studies enrolled elderly patients with primary NSCLC who received platinum-based adjuvant chemotherapy after radical resection and reported survival or adverse events. Two reviewers independently performed selection and extraction; risk of bias was assessed with RoBANS 2.0. Random-effects models (REML estimator, Hartung-Knapp-Sidik-Jonkman adjustment) pooled hazard ratios (HRs) for survival and adjusted odds ratios for adverse events. Subgroup analyses, meta-regression, and Egger's test were performed.
RESULTS: Fourteen studies were included qualitatively and ten quantitatively, spanning randomized controlled trials (RCTs) and retrospective matched cohorts across North America, Europe, and Asia. Adjuvant chemotherapy was associated with reduced mortality versus surgery alone (HR 0.82; 95% CI 0.75-0.91; I²=36%). Benefits were consistent across age subgroups (≥65: HR 0.85; ≥70: HR 0.80; ≥75: HR 0.63) and stages (I: HR 0.82; II-III: HR 0.63). Retrospective studies showed a clear benefit (HR 0.81; 95% CI 0.74-0.88), whereas pooled RCT subgroups did not (HR 0.90; 95% CI 0.56-1.42); study design explained over 77% of heterogeneity. No publication bias was detected (Egger's p=0.968). Chemotherapy increased hematologic toxicities (neutropenia OR 13.5-21.2), gastrointestinal events, renal impairment, and infections, which were generally manageable and did not offset the survival gain.
CONCLUSIONS: Platinum-based adjuvant chemotherapy was associated with a survival benefit in elderly resected NSCLC patients, consistent across age and stage, though largely driven by retrospective evidence while RCT subgroup data remained inconclusive. Toxicity was frequent but manageable, supporting carefully monitored use in selected elderly patients.