Umbrella decision-making model for diagnosis and treatment of elderly lung cancer patients: Construction and practice_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 LIU Lunxu ¹ , ZHOU Jian ¹ , DING Xiang ² , CHEN Nan ¹ , XUE Jianxin ³ , MA Xuelei ³ , WANG Ye ⁴ , WANG Weiya ⁵ , PENG Liqing ⁶ , YOU Xin ³ , SU Minggang ⁷ , CHENG Xu ⁸ , WANG Jiao ⁹ , GE Ning ² , KANG Deying ¹⁰ , HUANG Yuchen ¹ , WANG Jinghan ¹ , TONG Yu ¹ , ZHANG Yaoxi ¹ ,  YUE Jirong ² ,  LIAO Hu ¹

1. Department of Thoracic Surgery, Institute of Thoracic Oncology, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
2. National Clinical Research Center for Geriatrics, Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
3. Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
4. Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
5. Department of Pathology, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
6. Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
7. Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
8. Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
9. Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;
10. Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding?author：

LIU Lunxu, Email: liaotiger_198653@163.com; YUE Jirong, Email: yuejirong11@hotmail.com; LIAO Hu, Email: lunxu_liu@aliyun.com

Keywords：

Elderly lung cancer; umbrella decision-making; diagnosis and treatment model; application innovation; clinical practice; multidisciplinary team (MDT); oncological indicators; comprehensive geriatric assessment (CGA)

DOI：

10.7507/1007-4848.202605030

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

With the accelerating trend of population aging, the number of elderly patients with lung cancer continues to rise, and the disease burden is becoming increasingly heavy. The clinical management of these patients faces severe challenges due to their decreased physiological reserve, complex comorbidities, and significant individual heterogeneity. Consequently, under traditional diagnosis and treatment models, doctors often struggle to identify the individualized risks of elderly patients in a timely and comprehensive manner, which can easily lead to decision biases such as undertreatment or overtreatment. In view of this, this study advocates for the establishment of an umbrella decision-making model specifically tailored for elderly lung cancer patients. Grounded in a multidisciplinary team (MDT) platform, this model deeply integrates oncological indicators with the comprehensive geriatric assessment (CGA) system. By holistically considering multidimensional variables including tumor burden, organ function, frailty index, cognitive status, and social support, the model establishes an operational mechanism characterized by "single entry, precise stratification, and targeted selection". Accordingly, patients can be scientifically triaged into distinct intervention tiers, such as active surveillance, minimally invasive surgery, drug therapy, radiotherapy, and best supportive care, thereby achieving real-time alignment between treatment intensity and patient fitness. This article elaborates on the construction logic and key operational procedures of this novel decision-making framework, aiming to guide clinical practice beyond the limitations of a tumor-centric perspective toward a holistic, dynamic, whole-course management strategy. This transition seeks to ensure optimal quality of life and clinical net benefit for elderly patients alongside survival prolongation.

Citation： LIU Lunxu, ZHOU Jian, DING Xiang, CHEN Nan, XUE Jianxin, MA Xuelei, WANG Ye, WANG Weiya, PENG Liqing, YOU Xin, SU Minggang, CHENG Xu, WANG Jiao, GE Ning, KANG Deying, HUANG Yuchen, WANG Jinghan, TONG Yu, ZHANG Yaoxi, YUE Jirong, LIAO Hu. Umbrella decision-making model for diagnosis and treatment of elderly lung cancer patients: Construction and practice. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2026, 33(6): 833-839. doi: 10.7507/1007-4848.202605030 Copy

1.	Diao X, Guo C, Jin Y, et al. Cancer situation in China: an analysis based on the global epidemiological data released in 2024. Cancer Commun, 2025, 45(2): 178-197.
2.	Almodovar T, Teixeira E, Barroso A, et al. Elderly patients with advanced NSCLC: the value of geriatric evaluation and the feasibility of CGA alternatives in predicting chemotherapy toxicity. Pulmonology, 2019, 25(1): 40-50.
3.	Bade BC, Dela Cruz CS. Lung cancer 2020: epidemiology, etiology, and prevention. Clin Chest Med, 2020, 41(1): 1-24.
4.	Su C, Zhou F, Shen J, et al. Treatment of elderly patients or patients who are performance status 2 (PS2) with advanced non-small cell lung cancer without epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) translocations - still a daily challenge. Eur J Cancer, 2017, 83: 266-278.
5.	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.Geriatric Oncology Expert Committee of Chinese Society of Clinical Oncology. Expert consensus on the treatment of elderly patients with advanced lung cancer (2025 edition). Chin J Oncol, 2025, 47(7): 575-598.
6.	Schulkes KJ, Souwer ET, Hamaker ME, et al. The effect of a geriatric assessment on treatment decisions for patients with lung cancer. Lung, 2017, 195(2): 225-231.
7.	周小芹, 劉慧珍, 王婷, 等. 腫瘤藥物臨床試驗設計之傘式試驗. 中國胸心血管外科臨床雜志, 2023, 30(9): 1228-1234.Zhou XQ, Liu HZ, Wang T, et al. Umbrella trial: a design of oncology drug clinical trials. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(9): 1228-1234.
8.	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.
9.	Corre R, Greillier L, Le Ca?r H, et al. Use of a comprehensive geriatric assessment for the management of elderly patients with advanced non-small-cell lung cancer: the phase Ⅲ randomized ESOGIA-GFPC-GECP 08-02 study. J Clin Oncol, 2016, 34(13): 1476-1483.
10.	陳旭嬌, 嚴靜, 王建業, 等. 中國老年綜合評估技術應用專家共識. 中華老年病研究電子雜志, 2017, 4(2): 1-6.Chen XJ, Yan J, Wang JY, et al. Expert consensus on the application of comprehensive geriatric assessment in China. Chin J Geriatr Res (Electron Ed), 2017, 4(2): 1-6.
11.	Chiec L, Roof L, Hsu ML, et al. Lung cancer in older adults: screening, diagnosis, and treatment. Clin Geriatr Med, 2025, 41(4): 553-567.
12.	Ferreira V, Lawson C, Ekmekjian T, et al. Effects of preoperative nutrition and multimodal prehabilitation on functional capacity and postoperative complications in surgical lung cancer patients: a systematic review. Support Care Cancer, 2021, 29(10): 5597-5610.
13.	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, 2023, 165(5): 1260-1270.
14.	Dhesi J, Moonesinghe SR, Partridge J. Comprehensive geriatric assessment in the perioperative setting; where next? Age Ageing, 2019, 48(5): 624-627.
15.	Smits MJI, Lebens IJ, Vondeling AM, et al. Multidisciplinary decision-making and course of treatment in older patients with colorectal cancer: effect of geriatrician input. J Geriatr Oncol, 2023, 14(2): 101448.
16.	Prabhakaran CN, Fong KM, Peake MD, et al. The effectiveness of lung cancer MDT and the role of respiratory physicians. Respirology, 2015, 20(6): 884-888.
17.	Kidane B, Toyooka S, Yasufuku K. MDT lung cancer care: input from the Surgical Oncologist. Respirology, 2015, 20(7): 1023-1033.
18.	Kaiser MJ, Bauer JM, Ramsch C, et al. Validation of the mini nutritional assessment short-form (MNA-SF): a practical tool for identification of nutritional status. J Nutr Health Aging, 2009, 13(9): 782-788.
19.	Palmer K, Onder G. Comprehensive geriatric assessment: benefits and limitations. Eur J Intern Med, 2018, 54: e8-e9.
20.	Kshatri JS, Sahu SR, Behera SD, et al. Development and validation of the multidimensional elderly health status assessment and screening (EHSAS) tool for community-dwelling older people in rural India. Age Ageing, 2025, 54(12): afaf344.
21.	Partridge JSL, Moonesinghe SR, Lees N, et al. Perioperative care for older people. Age Ageing, 2022, 51(8): afac194.
22.	Oliver CM, Wagstaff D, Bedford J, et al. Systematic development and validation of a predictive model for major postoperative complications in the Peri-operative Quality Improvement Project (PQIP) dataset. Anaesthesia, 2024, 79(4): 389-398.
23.	Liu KH, Hung YS, Lee SH, et al. External validation of a risk model for survival prediction in older patients with cancer undergoing elective abdominal surgery: a prospective cohort study. Am J Cancer Res, 2022, 12(11): 5085-5094.

1. Diao X, Guo C, Jin Y, et al. Cancer situation in China: an analysis based on the global epidemiological data released in 2024. Cancer Commun, 2025, 45(2): 178-197.
2. Almodovar T, Teixeira E, Barroso A, et al. Elderly patients with advanced NSCLC: the value of geriatric evaluation and the feasibility of CGA alternatives in predicting chemotherapy toxicity. Pulmonology, 2019, 25(1): 40-50.
3. Bade BC, Dela Cruz CS. Lung cancer 2020: epidemiology, etiology, and prevention. Clin Chest Med, 2020, 41(1): 1-24.
4. Su C, Zhou F, Shen J, et al. Treatment of elderly patients or patients who are performance status 2 (PS2) with advanced non-small cell lung cancer without epidermal growth factor receptor (EGFR) mutations and anaplastic lymphoma kinase (ALK) translocations - still a daily challenge. Eur J Cancer, 2017, 83: 266-278.
5. 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.Geriatric Oncology Expert Committee of Chinese Society of Clinical Oncology. Expert consensus on the treatment of elderly patients with advanced lung cancer (2025 edition). Chin J Oncol, 2025, 47(7): 575-598.
6. Schulkes KJ, Souwer ET, Hamaker ME, et al. The effect of a geriatric assessment on treatment decisions for patients with lung cancer. Lung, 2017, 195(2): 225-231.
7. 周小芹, 劉慧珍, 王婷, 等. 腫瘤藥物臨床試驗設計之傘式試驗. 中國胸心血管外科臨床雜志, 2023, 30(9): 1228-1234.Zhou XQ, Liu HZ, Wang T, et al. Umbrella trial: a design of oncology drug clinical trials. Chin J Clin Thorac Cardiovasc Surg, 2023, 30(9): 1228-1234.
8. 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.
9. Corre R, Greillier L, Le Ca?r H, et al. Use of a comprehensive geriatric assessment for the management of elderly patients with advanced non-small-cell lung cancer: the phase Ⅲ randomized ESOGIA-GFPC-GECP 08-02 study. J Clin Oncol, 2016, 34(13): 1476-1483.
10. 陳旭嬌, 嚴靜, 王建業, 等. 中國老年綜合評估技術應用專家共識. 中華老年病研究電子雜志, 2017, 4(2): 1-6.Chen XJ, Yan J, Wang JY, et al. Expert consensus on the application of comprehensive geriatric assessment in China. Chin J Geriatr Res (Electron Ed), 2017, 4(2): 1-6.
11. Chiec L, Roof L, Hsu ML, et al. Lung cancer in older adults: screening, diagnosis, and treatment. Clin Geriatr Med, 2025, 41(4): 553-567.
12. Ferreira V, Lawson C, Ekmekjian T, et al. Effects of preoperative nutrition and multimodal prehabilitation on functional capacity and postoperative complications in surgical lung cancer patients: a systematic review. Support Care Cancer, 2021, 29(10): 5597-5610.
13. 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, 2023, 165(5): 1260-1270.
14. Dhesi J, Moonesinghe SR, Partridge J. Comprehensive geriatric assessment in the perioperative setting; where next? Age Ageing, 2019, 48(5): 624-627.
15. Smits MJI, Lebens IJ, Vondeling AM, et al. Multidisciplinary decision-making and course of treatment in older patients with colorectal cancer: effect of geriatrician input. J Geriatr Oncol, 2023, 14(2): 101448.
16. Prabhakaran CN, Fong KM, Peake MD, et al. The effectiveness of lung cancer MDT and the role of respiratory physicians. Respirology, 2015, 20(6): 884-888.
17. Kidane B, Toyooka S, Yasufuku K. MDT lung cancer care: input from the Surgical Oncologist. Respirology, 2015, 20(7): 1023-1033.
18. Kaiser MJ, Bauer JM, Ramsch C, et al. Validation of the mini nutritional assessment short-form (MNA-SF): a practical tool for identification of nutritional status. J Nutr Health Aging, 2009, 13(9): 782-788.
19. Palmer K, Onder G. Comprehensive geriatric assessment: benefits and limitations. Eur J Intern Med, 2018, 54: e8-e9.
20. Kshatri JS, Sahu SR, Behera SD, et al. Development and validation of the multidimensional elderly health status assessment and screening (EHSAS) tool for community-dwelling older people in rural India. Age Ageing, 2025, 54(12): afaf344.
21. Partridge JSL, Moonesinghe SR, Lees N, et al. Perioperative care for older people. Age Ageing, 2022, 51(8): afac194.
22. Oliver CM, Wagstaff D, Bedford J, et al. Systematic development and validation of a predictive model for major postoperative complications in the Peri-operative Quality Improvement Project (PQIP) dataset. Anaesthesia, 2024, 79(4): 389-398.
23. Liu KH, Hung YS, Lee SH, et al. External validation of a risk model for survival prediction in older patients with cancer undergoing elective abdominal surgery: a prospective cohort study. Am J Cancer Res, 2022, 12(11): 5085-5094.

Next Article
Surgical timing for patients with infective endocarditis complicated with intracranial hemorrhage: Controversies and consensus

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Umbrella decision-making model for diagnosis and treatment of elderly lung cancer patients: Construction and practice

Abstract Full text Figures/Tables Video References Cited by

Next Article

Format

Content