Evaluation system for standardized surgery in elderly patients with lung cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

MI Xingqi ¹ , CHEN Nan ¹ , MEI Jiandong ¹ , LI Hecheng ² , ZHANG Shuguang ³ , CHEN Huanwen ⁴ , JIAO Peng ⁵ , WANG Jun ⁶ , ZHANG Chunfang ⁷ , ZHANG Guangjian ⁸ , LI Xin ⁹ , PU Qiang ¹ ,  LIN Peng ¹⁰ ,  LIU Lunxu ¹

1. Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, P. R. China;
3. Department of Thoracic Surgery, The First Hospital of China Medical University, Shenyang, 110001, P. R. China;
4. Department of Thoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P. R. China;
5. Department of Thoracic Surgery, Beijing Hospital, Beijing, 100730, P. R. China;
6. Department of Thoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, P. R. China;
7. Department of Thoracic Surgery, Xiangya Hospital, Central South University, Changsha, 410008, P. R. China;
8. Department of Thoracic Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, 710061, P. R. China;
9. Department of Lung Cancer Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, P. R. China;
10. Department of Thoracic Surgery, Sun Yat-sen University Cancer Center, Guangzhou, 510060, P. R. China;

Corresponding?author：

LIN Peng, Email: lunxu_liu@aliyun.com; LIU Lunxu, Email: linpeng@sysucc.org.cn

Keywords：

Lung cancer; elderly; surgery; quality control; evaluation system

DOI：

10.7507/1007-4848.202605026

Video：

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To address the growing challenge of an increasing number of elderly lung cancer patients amidst China's aging population and to fill the gap in quality control standards for surgical treatment in this special population, this study aimed to develop a standardized surgical evaluation system for elderly lung cancer patients tailored to China's national conditions. The system was established through a literature review, integrated the pathophysiological characteristics of elderly patients, and was constructed following review, feedback, and revision by experts from multiple thoracic surgery centers. Employing a 100-point scoring system, it comprises three primary domains: physical infrastructure and geriatric adaptability foundational conditions (10 points); management level and perioperative care models (20 points); and technical proficiency and clinical outcomes (70 points). The system places a strong emphasis on geriatric adaptability, proposing specific, quantifiable indicators for age-friendly facility modifications, control of elderly-specific complications, multidisciplinary collaboration, and standardized perioperative management. It provides a convenient and measurable assessment tool for quality control in the surgical treatment of elderly lung cancer in China, which is expected to promote the standardization and homogenization of diagnosis and treatment.

Citation： MI Xingqi, CHEN Nan, MEI Jiandong, LI Hecheng, ZHANG Shuguang, CHEN Huanwen, JIAO Peng, WANG Jun, ZHANG Chunfang, ZHANG Guangjian, LI Xin, PU Qiang, LIN Peng, LIU Lunxu. Evaluation system for standardized surgery in elderly patients with lung cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2026, 33(6): 866-873. doi: 10.7507/1007-4848.202605026 Copy

1.	Qi J, Li M, Wang L, et al. National and subnational trends in cancer burden in China, 2005-20: an analysis of national mortality surveillance data. Lancet Public Health, 2023, 8(12): e943-e955.
2.	韓冰峰, 鄭榮壽, 曾紅梅, 等. 2024年中國人群惡性腫瘤發病與死亡年齡特征分析. 中國腫瘤, 2026, 35(3): 163-171.Han BF, Zheng RS, Zeng HM, et al. Age distribution of cancer incidence and mortality in China in 2024. China Cancer, 2026, 35(3): 163-171.
3.	Zheng R, Zhang S, Wang S, et al. Lung cancer incidence and mortality in China: updated statistics and an overview of temporal trends from 2000 to 2016. J Natl Cancer Cent, 2022, 2(3): 139-147.
4.	Rajaram R, Huang Q, Li RZ, et al. Recurrence-free survival in patients with surgically resected non-small cell lung cancer: a systematic literature review and meta-analysis. Chest, 2024, 165(5): 1260-1270.
5.	Thompson LL, Amin PM, Shah S, et al. Associations between G8 geriatric screening score, Charlson comorbidity index, AI-based age phenotype, and overall survival in older adults with stage Ⅰ-Ⅱ non-small cell lung cancer. Int J Radiat Oncol Biol Phys, 2025, 123(5): 1295-1305.
6.	Nipp RD, Subbiah IM, Loscalzo M. Convergence of geriatrics and palliative care to deliver personalized supportive care for older adults with cancer. J Clin Oncol, 2021, 39(19): 2185-2194.
7.	宋宇豪, 田文鑫, 李東航, 等. 老年肺癌患者圍術期心肺并發癥的早期識別與干預策略. 中國胸心血管外科臨床雜志, 2026, 33(5): 710-716.Song YH, Tian WX, Li DH, et al. Early recognition and intervention strategy of perioperative cardiopulmonary complications in elderly patients with lung cancer. Chin J Clin Thorac Cardiovasc Surg, 2026, 33(5): 710-716.
8.	李代萍, 梁瑞, 李霖龍, 等. 老年肺癌患者圍術期綜合管理指南 (2025) 計劃書. 中國循證醫學雜志, 2025, 25(12): 1379-1383.Li DP, Liang R, Li LL, et al. Protocol for guidelines on the comprehensive perioperative management of elderly patients with lung cancer (2025). Chin J Evid-Based Med, 2025, 25(12): 1379-1383.
9.	周南希, 王嬌, 胥琳, 等. 老年肺癌患者術后綜合康復新策略. 中國胸心血管外科臨床雜志, 2025. Epub ahead of print.Zhou NX, Wang J, Xu L, et al. New strategy of postoperative comprehensive rehabilitation for elderly patients with lung cancer. Chin J Clin Thorac Cardiovasc Surg, 2025. Epub ahead of print.
10.	Wang P, Wang S, Huang Q, et al. Development and validation of the systemic nutrition/inflammation index for improving perioperative management of non-small cell lung cancer. BMC Med, 2025, 23(1): 113.
11.	冷雪峰, 金健, 叢偉, 等. 成都市胸外科醫療質量控制中心體系建設實踐與討論. 中國胸心血管外科臨床雜志, 2018, 25(6): 453-457.Leng XF, Jin J, Cong W, et al. Practice and discussion on the construction of thoracic surgery medical quality control center system in Chengdu. Chin J Clin Thorac Cardiovasc Surg, 2018, 25(6): 453-457.
12.	謝冬, 陳昶, 姜格寧. 普胸外科手術質量控制與評估體系. 中國胸心血管外科臨床雜志, 2019, 26(1): 8-15.Xie D, Chen C, Jiang GN. Quality control and assessment system in general thoracic surgery. Chin J Clin Thorac Cardiovasc Surg, 2019, 26(1): 8-15.
13.	Riely GJ, Wood DE, Aisner DL, et al. NCCN guidelines? insights: non-small cell lung cancer, version 7. 2025. J Natl Compr Canc Netw, 2025, 23(9): 354-362.
14.	中華醫學會腫瘤學分會. 中華醫學會肺癌臨床診療指南 (2025版). 中華腫瘤雜志, 2025, 47(9): 769-810.Oncology Society of Chinese Medical Association. Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2025 edition). Chin J Oncol, 2025, 47(9): 769-810.
15.	Okumura M, Fujimoto K, Hanaoka N, et al. Medical practice guidelines for lung cancers including malignant pleural mesotheliomas and thymic tumors according to evidence-based medicine. 2024. Edited by the Japan Lung Cancer Society. Chapter 3 guidelines for thymic epithelial tumors: summary of recommendations. Respir Investig, 2025, 63(6): 1115-1119.
16.	Wildiers H, Heeren P, Puts M, et al. International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol, 2014, 32(24): 2595-2603.
17.	Rabinovich EP, Martin LW. Getting patients to adjuvant therapy after lung cancer resection: ERAS protocols and return to intended oncologic therapy. J Thorac Cardiovasc Surg, 2025, 169(5): 1367-1372.
18.	Miller RL, Barnes JD, Mouton R, et al. Comprehensive geriatric assessment (CGA) in perioperative care: a systematic review of a complex intervention. BMJ Open, 2022, 12(10): e062729.
19.	Lobo DN, Joshi GP, Kehlet H. Challenges in enhanced recovery after surgery (ERAS) research. Br J Anaesth, 2024, 133(4): 717-721.
20.	儲曉天, 王巧玲, 石偉宏, 等. 基于改良德爾菲法構建老年肺癌患者圍手術期身體機能及功能康復多維度評價體系. 華西醫學, 2025, 40(12): 1949-1955.Chu XT, Wang QL, Shi WH, et al. Construction of a multi-dimensional evaluation system for physical function and functional rehabilitation of elderly patients with lung cancer during perioperative period based on modified Delphi method. West China Med J, 2025, 40(12): 1949-1955.
21.	Dale W, Klepin HD, Williams GR, et al. Practical assessment and management of vulnerabilities in older patients receiving systemic cancer therapy: ASCO guideline update. J Clin Oncol, 2023, 41(26): 4293-4312.
22.	Kenis C, Peeters L, Laethem L, et al. Effectiveness of comprehensive geriatric assessment with extensive patient coaching for improving quality of life in older patients with solid tumours receiving systemic therapy (G-oncoCOACH): a multicentre randomised controlled trial. Lancet Healthy Longev, 2025, 6(8): 100743.
23.	Anwar MR, Yeretzian ST, Ayala AP, et al. Effectiveness of geriatric assessment and management in older cancer patients: a systematic review and meta-analysis. J Natl Cancer Inst, 2023, 115(12): 1483-1496.
24.	中國臨床腫瘤學會老年腫瘤防治專家委員會. 老年晚期肺癌治療專家共識 (2025版). 中華腫瘤雜志, 2025, 47(7): 575-598.Expert Committee on Geriatric Oncology Prevention and Treatment, Chinese Society of Clinical Oncology. Expert consensus on the treatment of advanced lung cancer in elderly patients (2025 edition). Chin J Oncol, 2025, 47(7): 575-598.
25.	Lindqvist J, Jekunen A, Sihvo E, et al. Effect of adherence to treatment guidelines on overall survival in elderly non-small-cell lung cancer patients. Lung Cancer, 2022, 171: 9-17.
26.	Seastedt KP, Moukheiber D, Mahindre SA, et al. A scoping review of artificial intelligence applications in thoracic surgery. Eur J Cardiothorac Surg, 2022, 61(2): 239-248.
27.	王蕾, 向之明. 人工智能聯合三維重建在胸腔鏡肺結節切除術中的應用進展. 中國胸心血管外科臨床雜志, 2025, 32(2): 252-257.Wang L, Xiang ZM. Advances in the application of AI-assisted 3D reconstruction in thoracoscopic pulmonary nodule resection surgery. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(2): 252-257.
28.	Li J, Fu J, Geng X, et al. Foundation models in clinical oncology: progresses and perspectives. Cancer Lett, 2026, 639: 218220.
29.	Xiao T, Kong S, Zhang Z, et al. A review of big data technology and its application in cancer care. Comput Biol Med, 2024, 176: 108577.
30.	Farjah F, Detterbeck FC. What is quality, and can we define it in lung cancer?-the case for quality improvement. Transl Lung Cancer Res, 2015, 4(4): 365-372.

1. Qi J, Li M, Wang L, et al. National and subnational trends in cancer burden in China, 2005-20: an analysis of national mortality surveillance data. Lancet Public Health, 2023, 8(12): e943-e955.
2. 韓冰峰, 鄭榮壽, 曾紅梅, 等. 2024年中國人群惡性腫瘤發病與死亡年齡特征分析. 中國腫瘤, 2026, 35(3): 163-171.Han BF, Zheng RS, Zeng HM, et al. Age distribution of cancer incidence and mortality in China in 2024. China Cancer, 2026, 35(3): 163-171.
3. Zheng R, Zhang S, Wang S, et al. Lung cancer incidence and mortality in China: updated statistics and an overview of temporal trends from 2000 to 2016. J Natl Cancer Cent, 2022, 2(3): 139-147.
4. Rajaram R, Huang Q, Li RZ, et al. Recurrence-free survival in patients with surgically resected non-small cell lung cancer: a systematic literature review and meta-analysis. Chest, 2024, 165(5): 1260-1270.
5. Thompson LL, Amin PM, Shah S, et al. Associations between G8 geriatric screening score, Charlson comorbidity index, AI-based age phenotype, and overall survival in older adults with stage Ⅰ-Ⅱ non-small cell lung cancer. Int J Radiat Oncol Biol Phys, 2025, 123(5): 1295-1305.
6. Nipp RD, Subbiah IM, Loscalzo M. Convergence of geriatrics and palliative care to deliver personalized supportive care for older adults with cancer. J Clin Oncol, 2021, 39(19): 2185-2194.
7. 宋宇豪, 田文鑫, 李東航, 等. 老年肺癌患者圍術期心肺并發癥的早期識別與干預策略. 中國胸心血管外科臨床雜志, 2026, 33(5): 710-716.Song YH, Tian WX, Li DH, et al. Early recognition and intervention strategy of perioperative cardiopulmonary complications in elderly patients with lung cancer. Chin J Clin Thorac Cardiovasc Surg, 2026, 33(5): 710-716.
8. 李代萍, 梁瑞, 李霖龍, 等. 老年肺癌患者圍術期綜合管理指南 (2025) 計劃書. 中國循證醫學雜志, 2025, 25(12): 1379-1383.Li DP, Liang R, Li LL, et al. Protocol for guidelines on the comprehensive perioperative management of elderly patients with lung cancer (2025). Chin J Evid-Based Med, 2025, 25(12): 1379-1383.
9. 周南希, 王嬌, 胥琳, 等. 老年肺癌患者術后綜合康復新策略. 中國胸心血管外科臨床雜志, 2025. Epub ahead of print.Zhou NX, Wang J, Xu L, et al. New strategy of postoperative comprehensive rehabilitation for elderly patients with lung cancer. Chin J Clin Thorac Cardiovasc Surg, 2025. Epub ahead of print.
10. Wang P, Wang S, Huang Q, et al. Development and validation of the systemic nutrition/inflammation index for improving perioperative management of non-small cell lung cancer. BMC Med, 2025, 23(1): 113.
11. 冷雪峰, 金健, 叢偉, 等. 成都市胸外科醫療質量控制中心體系建設實踐與討論. 中國胸心血管外科臨床雜志, 2018, 25(6): 453-457.Leng XF, Jin J, Cong W, et al. Practice and discussion on the construction of thoracic surgery medical quality control center system in Chengdu. Chin J Clin Thorac Cardiovasc Surg, 2018, 25(6): 453-457.
12. 謝冬, 陳昶, 姜格寧. 普胸外科手術質量控制與評估體系. 中國胸心血管外科臨床雜志, 2019, 26(1): 8-15.Xie D, Chen C, Jiang GN. Quality control and assessment system in general thoracic surgery. Chin J Clin Thorac Cardiovasc Surg, 2019, 26(1): 8-15.
13. Riely GJ, Wood DE, Aisner DL, et al. NCCN guidelines? insights: non-small cell lung cancer, version 7. 2025. J Natl Compr Canc Netw, 2025, 23(9): 354-362.
14. 中華醫學會腫瘤學分會. 中華醫學會肺癌臨床診療指南 (2025版). 中華腫瘤雜志, 2025, 47(9): 769-810.Oncology Society of Chinese Medical Association. Chinese Medical Association guideline for clinical diagnosis and treatment of lung cancer (2025 edition). Chin J Oncol, 2025, 47(9): 769-810.
15. Okumura M, Fujimoto K, Hanaoka N, et al. Medical practice guidelines for lung cancers including malignant pleural mesotheliomas and thymic tumors according to evidence-based medicine. 2024. Edited by the Japan Lung Cancer Society. Chapter 3 guidelines for thymic epithelial tumors: summary of recommendations. Respir Investig, 2025, 63(6): 1115-1119.
16. Wildiers H, Heeren P, Puts M, et al. International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol, 2014, 32(24): 2595-2603.
17. Rabinovich EP, Martin LW. Getting patients to adjuvant therapy after lung cancer resection: ERAS protocols and return to intended oncologic therapy. J Thorac Cardiovasc Surg, 2025, 169(5): 1367-1372.
18. Miller RL, Barnes JD, Mouton R, et al. Comprehensive geriatric assessment (CGA) in perioperative care: a systematic review of a complex intervention. BMJ Open, 2022, 12(10): e062729.
19. Lobo DN, Joshi GP, Kehlet H. Challenges in enhanced recovery after surgery (ERAS) research. Br J Anaesth, 2024, 133(4): 717-721.
20. 儲曉天, 王巧玲, 石偉宏, 等. 基于改良德爾菲法構建老年肺癌患者圍手術期身體機能及功能康復多維度評價體系. 華西醫學, 2025, 40(12): 1949-1955.Chu XT, Wang QL, Shi WH, et al. Construction of a multi-dimensional evaluation system for physical function and functional rehabilitation of elderly patients with lung cancer during perioperative period based on modified Delphi method. West China Med J, 2025, 40(12): 1949-1955.
21. Dale W, Klepin HD, Williams GR, et al. Practical assessment and management of vulnerabilities in older patients receiving systemic cancer therapy: ASCO guideline update. J Clin Oncol, 2023, 41(26): 4293-4312.
22. Kenis C, Peeters L, Laethem L, et al. Effectiveness of comprehensive geriatric assessment with extensive patient coaching for improving quality of life in older patients with solid tumours receiving systemic therapy (G-oncoCOACH): a multicentre randomised controlled trial. Lancet Healthy Longev, 2025, 6(8): 100743.
23. Anwar MR, Yeretzian ST, Ayala AP, et al. Effectiveness of geriatric assessment and management in older cancer patients: a systematic review and meta-analysis. J Natl Cancer Inst, 2023, 115(12): 1483-1496.
24. 中國臨床腫瘤學會老年腫瘤防治專家委員會. 老年晚期肺癌治療專家共識 (2025版). 中華腫瘤雜志, 2025, 47(7): 575-598.Expert Committee on Geriatric Oncology Prevention and Treatment, Chinese Society of Clinical Oncology. Expert consensus on the treatment of advanced lung cancer in elderly patients (2025 edition). Chin J Oncol, 2025, 47(7): 575-598.
25. Lindqvist J, Jekunen A, Sihvo E, et al. Effect of adherence to treatment guidelines on overall survival in elderly non-small-cell lung cancer patients. Lung Cancer, 2022, 171: 9-17.
26. Seastedt KP, Moukheiber D, Mahindre SA, et al. A scoping review of artificial intelligence applications in thoracic surgery. Eur J Cardiothorac Surg, 2022, 61(2): 239-248.
27. 王蕾, 向之明. 人工智能聯合三維重建在胸腔鏡肺結節切除術中的應用進展. 中國胸心血管外科臨床雜志, 2025, 32(2): 252-257.Wang L, Xiang ZM. Advances in the application of AI-assisted 3D reconstruction in thoracoscopic pulmonary nodule resection surgery. Chin J Clin Thorac Cardiovasc Surg, 2025, 32(2): 252-257.
28. Li J, Fu J, Geng X, et al. Foundation models in clinical oncology: progresses and perspectives. Cancer Lett, 2026, 639: 218220.
29. Xiao T, Kong S, Zhang Z, et al. A review of big data technology and its application in cancer care. Comput Biol Med, 2024, 176: 108577.
30. Farjah F, Detterbeck FC. What is quality, and can we define it in lung cancer?-the case for quality improvement. Transl Lung Cancer Res, 2015, 4(4): 365-372.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Evaluation system for standardized surgery in elderly patients with lung cancer

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