Effects of different metastasis patterns, surgery and other factors on the prognosis of patients with stage�IV non‑small cell lung cancer: A Surveillance, Epidemiology, and End Results (SEER) linked database analysis

Abstract

The surgical treatment of patients with advanced lung cancer remains controversial. The current study aimed to identify the factors affecting the prognosis of patients with stage IV non-small cell lung cancer (NSCLC) and to clarify the surgery guidelines. A total of 27,725 patients diagnosed with stage IV NSCLC were selected from the Surveillance, Epidemiology, and End Results program between 2010 and 2013. The sex, age, ethnicity, marital status, Tumor-Node-Metastasis stage, radiation therapy received and surgical status of each patient were recorded. Patients were followed up to November 2015. Survival rates were estimated by the Kaplan-Meier method. Single-and multi-factor analyses were performed using the log-rank test and multivariate Cox regression analysis respectively. In the isolated organ metastasis cohort, patients with liver metastasis alone had the worst prognosis, with a median overall survival (OS) of 4 months (liver metastasis vs. other organ metastases; P<0.001). Patients with lung metastasis only had the best prognosis, with a median OS of 8 months (lung metastasis vs. other organ metastases; P<0.001). Furthermore, patients with only one metastasis had the best prognosis, with a median OS of 6 months (single metastasis vs. multiple-organ metastases; P<0.001). The multivariate Cox regression analysis of the isolated-organ metastasis cohort and the multiple-organ metastases cohort revealed that patients who were ≤60 years, female, married, Asian, with N 0 stage, had only bone metastasis, accepted wedge resection or lobectomy of the primary tumor, had surgical procedure to distant lymph node(s), and received beam radiation had an improved prognosis compared with the other patients. Age, sex, tumor type, ethnicity, N stage, number and type of metastatic lesions, surgical treatment of primary and metastatic lesions and radiation therapy are factors which influence the prognosis of patients with stage IV NSCLC. Furthermore, surgery may still benefit these patients.

Prognostic factors for survival in patients with metastatic lung adenocarcinoma: An analysis of the SEER database

“…Indeed, the comparison of several studies in a meta‐analysis confirmed that some targeted treatments were influenced by sex, 23 and one hypothesis is that the better survival outcomes shown by women may be due to different hormone and receptor expression levels 24 . Regarding age, our results that show better mOS values for patients younger than 65 years of age are in line with previous studies, in which age has been clearly identified as a factor affecting survival in NSCLC patients 25–27 . Other characteristics, such as living arrangements, also confirm previous data suggesting that living with others, along with the corresponding help and support, are associated with longer mOS compared to individuals who lack this support 25,28,29 .…”

Radiomics predicts survival of patients with advanced non‑small cell lung cancer undergoing PD‑1 blockade using Nivolumab

“…In this regard, we believe that the low number of patients analyzed, as well as the low ratio of females (19%) and the low standard deviation of the age (mean age 67.4 years +/-9.7 years) can easily justify these discrepancies with the literature (53). At the same time, the specific subset of patients analyzed (NSCLC patients in progression after first line chemotherapy) could also justify the non-significance of clinical variables such as sex and age.…”

Development of an Individualized Prediction Calculator for the Benefit of Postoperative Radiotherapy in Patients with Surgically Resected De Novo Stage IV Breast Cancer

“…With advances in systemic therapy, the mortality rate for patients with stage IV breast cancer is decreasing but overall survival (OS) remains unsatisfactory [ 4 ]. This is partly due to the fact that stage IV breast cancer has a heterogeneous prognosis ranging from a few months to many years due to differences in tumor biology and metastatic disease burden [ 5 , 6 , 7 , 8 ].…”