Radical local treatment for stage IV non-small cell lung cancer in older adults: a propensity-score matched analysis of the SEER database

Abstract

Background: Increased incidence of lung cancer in older adults is attributed to increased life expectancy, increased risk for many types of cancer, age-associated comorbidities and physical performance status.Contraindicatory tumor resection is suggested to benefit survival outcomes in stage IV non-small-cell lung cancer (NSCLC). We analyzed the clinical characteristics of older adults ≥70 years old with stage IV NSCLC and investigated whether radical local treatment may benefit this population. Methods: This retrospective, population-based cohort study analyzed patient data from the USA Surveillance, Epidemiology and End Results (SEER) Program during 2004-2016. Eligible patients were aged ≥70 years and diagnosed with stage IV NSCLC. Primary endpoints were overall survival (OS) and lung-cancer-specific survival (LCSS). Propensity-score matching (PSM) and Cox regression analysis were performed to assess the prognostic role of surgical resection of primary tumor or metastasis.Results: Among 54,310 stage IV NSCLC older patients, 7.50% received radical local treatment of the primary tumor or metastasis. PSM resulted in a balanced study population consisting of a treatment group (n=4,037) and a matched no-local-treatment group (n=15,658). After adjusting for confounders, radical local treatment was significantly associated with increased LCSS [hazard ratio (HR): 0.85, 95% confidence interval (95% CI): 0.72-1.00] but decreased OS (HR: 1.97, 95% CI: 1.31-2.97, P=0.0012). Conclusions:In older adults ≥70 years old with stage IV NSCLC, radical local treatment is associated with increased LCSS but decreased OS. Additional prospective studies are warranted to confirm the benefit of radical local treatment for primary or metastatic NSCLC.