Survival value of primary tumour resection for stage IV non–small‐cell lung cancer: A population‐based study of 6466 patients

Abstract

IntroductionFor stage IV non–small‐cell lung cancer (NSCLC) patients, surgical resection of primary tumour was rarely recommended.ObjectivesWe conducted this population‐based study to demonstrate the survival value of primary tumour resection (PTR) for stage IV (NSCLC).MethodsThe Surveillance, Epidemiology and End Results (SEER) database was searched for selecting stage IV NSCLC patients. The patients were matched according to age, gender, grade, primary tumour site, histopathological type, tumour size and regional lymph nodes metastasis by propensity score matching (PSM) analysis. Kaplan‐Meier curves were presented to show the survival differences between resection group and non‐resection group. Risk factors which were supposed to influence survival outcome were investigated using a Cox proportional hazard regression model. And a nomogram was performed to present prognostic factors for stage IV NSCLC patients.Results6466 patients diagnosed from 2004 to 2015 were included in survival analyses after PSM. The median overall survival (OS) for overall patients with resection was 27 months, much longer than those without resection (8 months). And this trend remained in subgroup analyses, including different histopathological types and distant metastases (All P values < 0.001). Younger age, race other than white and black, female, grade 1/2 (G1/G2), PTR, chemotherapy, no other distant metastases, smaller tumour size and no regional lymph node metastases were favourable prognostic factors for stage IV NSCLC. A predictive nomogram was conducted based on above risk factors.ConclusionPTR prolonged survival of stage IV NSCLC patients. And PTR should be considered in clinical practice for stage IV NSCLC.

Investigations of the distant metastatic non‐small cell lung cancer without local lymph node involvement: Real world data from a large database

“…18 In line with our results, Xu et al analyzed the data of 6466 stage IV NSCLC patients and demonstrated that the OS of NSCLC patients with primary tumor resection was superior to that of those without resection (27 vs. 8 months). 19 A similar scenario was also observed in the studies of Asamura et al 18 and Strand et al 20 In our view, resection of primary lesions could alleviate tumor-related symptoms and further improve patients' quality of life, which may extend patients' lives. Therefore, we suggest that although primary tumor resection is not recommended in the current guideline, 21 surgery is still a feasible treatment choice for M1 patients whose systemic condition is stable.…”

A clinical nomogram and heat map for assessing survival in patients with stage I non-small cell lung cancer after complete resection

“… 11 – 13 An increasing number of stage I NSCLC cases have been detected in recent years with the help of high-resolution low-dose CT for screening and diagnosis; however, the clinical nomograms for NSCLC were mostly established for patients with an advanced stage. 5 , 22 – 24 …”

“…[11][12][13] An increasing number of stage I NSCLC cases have been detected in recent years with the help of high-resolution low-dose CT for screening and diagnosis; however, the clinical nomograms for NSCLC were mostly established for patients with an advanced stage. 5,[22][23][24] Estimation of survival is important in the management of early stage NSCLC. Tumor size plays a prominent role in stage I NSCLC.…”

Primary Tumor Radiotherapy During EGFR-TKI Disease Control Improves Survival of Treatment Naïve Advanced EGFR-Mutant Lung Adenocarcinoma Patients

“… 38 In two retrospective studies taken from the SEER database, PTR was associated with an improved survival in patients with extrathoracic metastatic NSCLC. 22 , 39 These results imply that there is a potential role for PTR in stage IV NSCLC, and may also infer that local radiotherapy with a curative dose to the primary lung tumor could have similar effects to those resulting from primary tumor resection.…”