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. 2019 Apr;157(4):1620-1628.
doi: 10.1016/j.jtcvs.2018.10.140. Epub 2018 Nov 14.

Survival benefits associated with surgery for advanced non-small cell lung cancer

Elizabeth A David  1 , Stina W Andersen  2 , Laurel A Beckett  3 , Joy Melnikow  2 , James M Clark  4 , Lisa M Brown  4 , David T Cooke  4 , Karen Kelly  5 , Robert J Canter  5
Affiliations

Survival benefits associated with surgery for advanced non-small cell lung cancer

Elizabeth A David et al. J Thorac Cardiovasc Surg. 2019 Apr.

Abstract

Objective: Overall survival (OS) for advanced stage (IIIA-IV) non-small cell lung cancer (NSCLC) is highly variable, and retrospective data show a survival advantage for patients receiving therapeutic intent pulmonary resection. We hypothesized that this variability in OS can be modeled separately by stage to allow a personalized estimate of OS.

Methods: In a cohort of patients with advanced-stage NSCLC from the National Cancer Database, we assessed the accuracy of Surgical Selection Score (SSS) to predict OS using Cox proportional hazards models and determined by stage the effect of surgery on survival among people with similarly high levels of SSS.

Results: In total, 300,572 patients were identified; 18,701 (6%) had surgery. The SSS was a strong predictor of OS (C-index, 0.89; 95% confidence interval [CI], 0.89-0.90). We observed significantly greater OS (P < .001) among patients who had surgery. The hazard of death was at least 2 times greater for patients in the upper quartile of SSS who did not receive surgery compared with surgical patients even when adjusting for the SSS (stage IIIA: hazard ratio [HR], 2.1; 95% CI, 2.0-2.2, stage IIIB: HR, 2.3; 95% CI, 2.2-2.5, stage IV: HR, 2.3; 95% CI, 2.2-2.4).

Conclusions: The SSS is highly predictive of individual OS and can be used as a risk assessment tool. These findings are important for a more robust evaluation of the likely benefits of surgical resection for these patients. After further prospective validation, the SSS can be used during treatment decision-making for patients with advanced-stage NSCLC.

Keywords: NSCLC; advanced stage; chemotherapy; multimodality treatment; radiation; surgery; survival.

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Figures

Figure 1.
Figure 1.
Cohort of Stage IIIA, IIIB and IV NSCLC patients from the NCDB
Figure 1.
Figure 1.
Cohort of Stage IIIA, IIIB and IV NSCLC patients from the NCDB
Figure 2.
Figure 2.
Kaplan-Meier analysis of patients stratified by stage. A. Stage IIIA B. Stage IIIB C. Stage IV Patients treated surgically have significantly longer OS across all stages.
Figure 2.
Figure 2.
Kaplan-Meier analysis of patients stratified by stage. A. Stage IIIA B. Stage IIIB C. Stage IV Patients treated surgically have significantly longer OS across all stages.
Figure 2.
Figure 2.
Kaplan-Meier analysis of patients stratified by stage. A. Stage IIIA B. Stage IIIB C. Stage IV Patients treated surgically have significantly longer OS across all stages.
Figure 3.
Figure 3.
Distribution of Surgical Selection Score and Kaplan-Meier 3-year Survival Probability. A. Stage IIIA B. Stage IIIB C. Stage IV Patients have significantly longer survival when surgery is included in their treatment regimens.
Figure 3.
Figure 3.
Distribution of Surgical Selection Score and Kaplan-Meier 3-year Survival Probability. A. Stage IIIA B. Stage IIIB C. Stage IV Patients have significantly longer survival when surgery is included in their treatment regimens.
Figure 3.
Figure 3.
Distribution of Surgical Selection Score and Kaplan-Meier 3-year Survival Probability. A. Stage IIIA B. Stage IIIB C. Stage IV Patients have significantly longer survival when surgery is included in their treatment regimens.
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References

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