Local thoracic therapy improve prognosis for stage IV non-small cell lung cancer patients combined with chemotherapy: A Surveillance, Epidemiology, and End Results database analysis

Abstract

Patients with stage IV non-small cell lung cancer (NSCLC) comprise a heterogeneous group, and the optimal treatment for this group of patients is complex and debatable. We aimed to assess the effect of local thoracic therapy combined with chemotherapy on cancer specific survival (CSS). To evaluate the CSS of four subgroups of patients with stage IV NSCLC according to four different treatment modalities: combined modality of Chemotherapy, Surgery, and Radiation (Chem+Sur+RT), Chemotherapy and Radiation (Chem+RT), Chemotherapy and Surgery (Chem+Sur), and Chemotherapy only (Chem Only) by analyzing the Surveillance, Epidemiology, and End Results (SEER)-registered database. Kaplan-Meier methods were adopted and multivariable Cox regression models were built for the analysis of survival outcomes and risk factors. The 3-year CSS was 33.5% in “Chem+Sur+RT” group, 9.3% in “Chem+RT” group, 42.7% in “Chem+Sur” group and 11.8% in “Chem Only” group, which had significant difference in univariate log-rank test (P<0.001) and multivariate Cox regression (P<0.001). Moreover, we observed significant survival benefits in “Chem+Sur” group in all stage of T/N categories, including stage I, stage II, stage IIIa and stage IIIb (all P<0.001). Multimodality therapy, especially combined thoracic surgery and chemotherapy is associated with dramatically improved prognosis for patients with stage IV NSCLC.

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

“…A previous study based on SEER program analysis suggested that no further surgical treatment is recommended for patients with advanced lung cancer (36). However, additional studies do not concur with this recommendation (37). Patients with stage IV NSCLC who received pneumonectomy and thoracic wall enlargement resection had an improved quality of life and 5-year survival (38).…”

Treatment Patterns and Survival Outcomes of Non-Small Cell Lung Cancer Patients Initially Diagnosed With Brain Metastases in Real-World Clinical Practice

“…Non-small-cell lung cancer (NSCLC) accounts for 80 to 85% of all lung cancers, and more than three-quarters of NSCLC patients present with advanced disease ( 1 , 2 ). Brain is one of the most common sites of NSCLC metastases, and 30 to 50% of these patients may develop brain metastases (BMs) at some point in their lives ( 3 , 4 ).…”

Primary Tumor Resection Is Associated with a Better Outcome among Advanced EGFR-Mutant Lung Adenocarcinoma Patients Receiving EGFR-TKI Treatment

“…The 5-year survival rate of all patients was 29.0%, which was much higher than previous historical reports. Liu et al [10] analyzed patients with lung cancer who were diagnosed from 2004 to 2013 in the SEER database and suggested the survival benefits of multimodality therapy, particularly combined chemotherapy and thoracic surgery. A recent population-based study conducted by Sun et al [22] also suggested the survival advantage from performing primary tumor resection.…”

“…In recent years, many studies have investigated whether local thoracic therapy can improve the outcome of advanced lung cancer [7-9]. The analysis of the Surveillance, Epidemiology, and End Results (SEER)-registered database suggested that multimodality therapy, particularly the addition of thoracic surgery to chemotherapy, is associated with a significantly better prognosis [10]. It remains unclear whether this phenomenon can be applied to EGFR -mutant patients receiving EGFR-TKI treatment, due to the heterogeneous patient population and inconsistent results of previous studies [11, 12].…”