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Surgical intervention may be a therapeutic option for NSCLC patients with AJCC stage IV: a large population-based study

Authors Wang H, Yan L, Li C, Wang Z

Received 19 April 2018

Accepted for publication 14 June 2018

Published 4 September 2018 Volume 2018:10 Pages 3219—3226

DOI https://doi.org/10.2147/CMAR.S171589

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Ms Justinn Cochran

Peer reviewer comments 3

Editor who approved publication: Professor Nakshatri


Haiyong Wang,1,* Lei Yan,1,* Cheng Li,2 Zhehai Wang1

1Department of Internal Medicine-Oncology, Shandong Cancer Hospital and Institute, Shandong Cancer Hospital, Shandong University, Shandong Academy of Medical Sciences, Jinan 250117, China; 2Department of School of Health Care Management, Shandong University, Key Laboratory of Health Economics and Policy Research, Jinan 250100, China

*These authors contributed equally to this work

Background: Few studies have focused on the role of surgery in the treatment of stage IV non-small cell lung cancer (NSCLC). In our study, we mainly focused on the surgical therapeutic option for NSCLC patients with American Joint Committee on Cancer stage IV.
Patients and methods: Using the Surveillance Epidemiology and End Results database, we screened out an appropriate patient population with stage IV NSCLC treated between 2004 and 2013. Kaplan–Meier curve analysis was used to compare the survival between patients receiving surgery and standard of care. The effect of surgery on primary and regional/distant sites on overall survival (OS) was further evaluated by Cox proportional hazard model. Finally, subgroup analysis based on patient and disease variables was conducted by Cox proportional hazard and presented as a forest plot.
Results: A total of 61,418 stage IV NSCLC patients were enrolled. However, only 11.6% received local surgical treatment. Surgery to primary and regional/distant sites were both independent prognostic factors of OS (P<0.001). Survival advantage was identified in those patients who received surgery to primary sites for all subgroup variables (P<0.001). However, survival benefit was not demonstrated for patients with surgery to regional/distant sites in some subgroup variables, including black racial background, squamous cell carcinoma, large cell carcinoma, and N1 staging (all, P>0.1). Importantly, we observed that surgery of primary tumor sites at stage N0 showed the maximum OS benefit (P<0.001).
Conclusion: These findings about N staging and primary tumor site treatment should be taken into consideration by surgeons when determining the suitability of surgery for stage IV NSCLC patients.

Keywords: lung cancer, surgery, stage IV, prognosis

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