Retrospective analysis of the occurrence pattern of complications and prognostic influencing factors in elderly patients with squamous cell lung cancer after radical surgery.

OBJECTIVE

To analyze the characteristics of postoperative complications and their prognostic effects in elderly patients with squamous cell lung cancer (SqCLC) who received radical surgery, identify independent prognostic factors, and build an individualized survival prediction model.

METHODS

This retrospective study included 260 elderly patients with SqCLC who underwent radical surgery. We collected and analyzed their clinicopathological data, postoperative complications and survival outcomes. Univariate and multivariate Cox regression analyses were used to screen prognostic factors for overall survival (OS). A nomogram for 2-year OS prediction was established and validated using receiver operating characteristic (ROC) curve, calibration curve and decision curve analysis (DCA).

RESULTS

The total incidence of postoperative complications was 38.1% (99/260), and pulmonary infection (14.6%) was the most common complication. Univariate analysis indicated that age, Eastern Cooperative Oncology Group Performance Status (ECOG PS), Charlson Comorbidity Index (CCI), 8th edition TNM stage and postoperative complications were significantly correlated with OS and progression-free survival (PFS) (all P < 0.05). Multivariate Cox regression identified advanced TNM stage (III-IV) (HR = 1.65, 95%CI 1.23-2.21, P < 0.001) and ECOG PS ≥ 2 (HR = 1.25, 95%CI 1.01-1.55, P < 0.05) as independent adverse prognostic factors for OS. Postoperative complications were significantly associated with poorer survival in univariate analysis but did not remain an independent prognostic factor in multivariate analysis. The nomogram integrating age, ECOG PS, CCI, TNM stage, and postoperative complication status yielded an area under the curve (AUC) of 0.82 (95%CI 0.77-0.87) for 2-year OS prediction, with excellent calibration and clinical net benefit.

CONCLUSION

Postoperative complications are highly prevalent in elderly SqCLC patients undergoing radical surgery and are significantly associated with inferior survival outcomes in univariate analysis. The proposed postoperative nomogram can accurately predict 2-year OS, and its clinical application is restricted to postoperative scenarios, including individualized prognostic counseling, surveillance planning, and risk stratification for this patient population.